Business Note Submission Form

First Name:
Last Name:
Your Time Zone:
Best time to call you back with a quote:
(Area code) Phone number:
Email address:
Your address:
Your City:
State:
Zip Code:
Business Information
Name of Business:
Type of Business:
Business address:
City:
State:
Zip Code:
Business County:
Is the operation a franchise?
If yes has franchisor committed to cooperate with Seller in the event of foreclosure or resale?
How long in business at this location?
Business location is :
If leased when does it expire?
Give terms of any lease renewal options:
What are the qualifications of Payor to operate this business:?
Is the payor a corporation?
If Payor is a Corporation does the note carry a Personal Guaranty of the Payor?
Payors Name:
Payors Address City State Zip:
Payors Credit is Believed to be:
Note payors credit score (if available):
Description of business location & area:
Receivable Information
Date of Sale:
Date of Sale:
Sales Price:
Down Payment:
Beginning balance (1st lien):
Beginning balance (2nd lien):
Date 1st Payment was Due (1st Lien):
Date the next payment is due (1st lien):
Term of Note (in months):
Number of Payments Made:
Number of Payments Remaining:
Interest Rate:
Payment frequency:
Payment amount 1st lien:
Balloon Payment Date (if any):
Balloon Payment Amount (if any):
Current Balance 1st Lien:
Additional Information
Equipment $:
Inventory $:
Goodwill $:
Non-Compete Agreement $:
Real Estate $:
Reason for Selling Note:
Do you have and can you supply copies of the following:
Promissory Note:
Security Instrument/Agreement:
Closing Statement:
UCC Filings:
Franchise Agreement:
Payors Credit Report:
Tax Returns:
Payment History:
Lease:
Insurance: