Business Note Submission Form

To receive a free, no obligation quote on your business note, please take a moment to complete the following worksheet or give us a

call toll free at 718.713.7064 Download the business work sheet here! Business Note Form The following forms are in either Word

or PDF format, PDF forms will require Acrobat Reader to view and print. If you do not currently have Acrobat Reader

you may download it free at the following link: http://www.adobe.com/products/acrobat/readstep2.html

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: