21st Century Funding Worksheet for Accounts Receivable

Your Email Address:

Contact Information

Your Name	
Date		
Phone		
FAX

Description of Property, Location & Area

Payor Information

Provide description and amount of average monthly invoices for your top 5 customers.

Motivation Information

Please explain why you need to sell the debt instrument, how much you expect for it, and how soon you need to close.

Pertinent Documents

Do I have the following:
Yes No - Note
Yes No - Security Instrument
Yes No - Title
Yes No - Sales Contract
Yes No - Payor credit report
Yes No - Closing Statement
Yes No - Bill of sale
Yes No - Insurance
Yes No - Lease
Yes No - Franchise agreement
Yes No - UCC-1

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