CONTACT INFORMATION

First Name *

Last Name *

Phone *

Email *

Title *

BUSINESS INFORMATION

Type of Business *

Property Street Address *

Property City *

Property Zip Code *

Property State *

Business Operating as Franchise *

Gross Annual Income *

Annual Business Expenses *

Net Operating Income *

Total Dollar Value of All Business Assets *

How Long in Business *

How Long at Location *

Business Location Is *

Terms of Lease Renewal Option(s) *

What qualification does the borrower have to run this business *

SALE INFORMATION

Date of Sale *

Sales Price *

Down Payment *

NOTE INFORMATION

Original Note Amount *

Lien Position of Note *

Note Balance *

Interest Rate *

Payment Amount *

Original Length *

Date of 1st Payment *

No. of Payments Made *

No. of Payments Remaining *

Next Payment Due Date *

Are the Payments on Time *

Was there a U.C.C. Filed & Recorded *

Balloon Amount

Balloon Due Date

BORROWER INFORMATION

Borrower Type *

Borrower Name(s) *

Did You Pull a Credit Report at Sale *

Borrower Credit Rating *

Is There a Personal Guarantee *

Anything Else We Should Know?

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