Business Name

Owner/Proprietor Name

Email Address

Phone Number

What is the best time to reach you?

Business Information:

Type of Business

How long in business?

Asset Value Breakdown:

Equipment

Inventory

Goodwill

Is operation a Franchise?

Yes
No

Is the note personally guaranteed?

Yes
No

Is the business location leased?

Yes
No

Street Address of Business

City

State

Note Information:

Sell Price of Business

Down payment

Original Note Balance

Months Financed

Interest Rate on Note

Date of First Payment

Monthly Payment Amount

Number of Payments Remaining

Balloon Payment

Yes
No

Current Balance of Note

Credit of Payer

Excellent
Good
Marginal
Bad
Unknown