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  1.  #4100
  2. @001 Please state the name of the owner of the property(lender):
  3. @002 Please state the name of the borrower of the property:
  4. @410 Please describe the property lent:
  5. @411 Please state length of loan:
  6. @412 Please state purpose of borrowing:
  7. #4101/#4102/  The property will be insured:
  8. By the owner
  9. By the borrower
  10. By neither, or contract does not state
  11. #if#4102
  12. @419 State required limits of insurance:
  13. #endif
  14. #4103 Do you desire to have an indemnity clause?
  15. #4104