Your Name Date Phone FAX
Type of Business Asset Value Breakdown: Equipment ($) Inventory ($) Goodwill ($) Is operation a Franchise? Yes No If yes, has franchisor committed to cooperate with note buyer in event of foreclosure/resale? No Yes Street Address (if available): How long in business at this location? Business location is Owned by Payor Leased by Payor If LEASED, Expires: Terms of any lease renewal option(s): What qualifications does the payor have to operate this business? If payor is a corporation, is there also a creditworthy individual liable for payments? Yes No If so, name: Historical Information Date of Sale Selling Price Down Payment 1st Lien 2nd Lien Note Information Date of Note Account ($) Term in months Payment account Balloon Amount Balloon Date Interest Rate Due Date 1st PMT # of payments paid # of payments left Next Payment due Balance Description of Business Location & Area Payor Information Please provide as much information as you can about the person making payments to you (Employment Info, Payment Record, Payor S.S.#, etc.) 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
Date of Sale Selling Price Down Payment 1st Lien 2nd Lien
Date of Note Account ($) Term in months Payment account Balloon Amount Balloon Date Interest Rate Due Date 1st PMT # of payments paid # of payments left Next Payment due Balance