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Get Initial Disbursement Form

Address: _______________________________________________________ City: _________________ State: ______________ Zip Code ______________________ Contractor: _______________________________ Total Contract Amount: $ ______________ Initial Disbursement Request Amount: $ ______________ (Initial disbursement may not exceed 50% of total contract amount and may only include actual cost of materials and permits) The above referenced borrower(s) hereby request an initial release of funds held in escrow .

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