Business Note Application Form

If you would like a no-obligation, no-charge market valuation of your business note, complete the preliminary information below. We will respond within 24 hours

(When you SEND the form, you will be returned to the HOME page)


*Note Holder Name
*Company Name (if any)
*Street Address
*City
*State
*Zip
*Fax Number (with area code)
Home Phone
*Email Address
*Type of Business (Describe)
*Business Street Address
*Business City
*Business State
*Business County
*Business Zip Code
*Describe Area Where Business Located
*How Long At This Location?
*Equipment Value $
*Inventory Value $
*Goodwill Value $
*How Long In Business At This Location?
*Is This Business A Franchise? (Yes, No)
*Franchisor Aware of Note Sale? (Yes, No)
*Is Business Location: (Owned Or Leased)
*If Leased, Explain Term & Renewal Options
*Is Payor: An Individual or Corporation?
*Name Of Individual Who Will Guaranty Note
*Date Business Was Sold
*Selling Price $
*Down Payment $
*First Lien $
*Second Lien $
*Date Of Note
*Amount Of Note $
*Term In Months (first lien)
*Term In Months (second lien)
*Payment Amount $ (first lien)
*Payment Amount $ (second lien)
*Ballon ? (Yes, No)
*Ballon Amount $
*Ballon Date
*Interest Rate % (first lien)
*Interest Rate % (second lien)
*Number Of Payments Made (first lien)
*Number of Payments Left (first lien)
*Due Date Next Payment (first lien)
*Balance $ (first lien)
*Has Payor Been Late on ANY Payments? (Yes, No)
*Note Holder's Motivation For Selling
*Amount Seller Needs $
	* Denotes a required field