Seller's Name: 

Address:       

 Phone:  ()          Fax:      ()  

  How did Note Seller hear of us? 

Type of Business:

Asset Value Breakdown:  Equipment $

                                          Inventory $ 

                                           Goodwill $

Is operation a Franchise?  Yes      No

Street Address:

City:

State: Zip:

County 

How long in business at this location?

Business Location is: Owned by Payor   Leased by Payor expires?

Give terms of any lease renewal option(s):

Qualifications of Payor to operate this  business:

Is Payor a corporation?  Yes   No

Is the Note personally guaranteed? Yes  No

HISTORICAL INFORMATION:

Date of  Sale:

Selling Price: 

Down Payment:

1^st Lien:        

2^nd Lien:       

NOTE INFORMATION:

Date of Note:

Amount:  

Terms of Months:  

Payment Amount:  

Balloon Amt:

Balloon Date:  

Interest Rate:

Due Date 1^st Pmt:

# of Pmts Paid:

# of Pmts Left:  

Next Pmt Due:

Balance:

DEAL STRUCTURE QUOTED TO SELLER:

Buy Total Note:

Buy Pmts for: 

Buy Pmts for: 

Date Quote Given: 

Closing Cost Pd by:  

DESCRIPTION OF BUSINESS

LOCATION AND AREA:

PAYOR / PAYMENT INFORMATION:

(Employment information, Payment Record, Payor  SSN)

MOTIVATION INFORMATION:

(Why, How Much, When etc.)

BROKER'S NAME:

Address:

 Phone:  ()        

 FAX:    ()  

BROKER COMMENTS:

UPON SELLER'S ACCEPTANCE OF QUOTE, WE WILL FAX A CHECKLIST OF DOCUMENTS NEEDED FOR OUR DUE DILIGENCE.