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Business Note
Worksheet |
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Bold fields are
required |
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Name: |
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Work#: |
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Fax#: |
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Cell# |
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Home#: |
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Best Time to
Call: |
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Email: |
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How Did You Hear of
Us:? |
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Company
Name: |
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Address: |
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City: |
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State: |
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Zip: |
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Type of
Business: |
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Asset Value
Breakdown |
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Equipment:$ |
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Inventory:$ |
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Goodwill:$ |
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How Long in Business at This
Location:? |
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Business Location Owned
by:? |
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Leased by Payer
Expires:? |
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Terms of Lease Renewal
Options: |
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Is This a
Franchise:? |
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Payor
Information |
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Name(s): |
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Social Security
#: |
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Names(s): |
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Social Security
#: |
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Address: |
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City: |
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State: |
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Zip: |
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Business Note
Information |
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Date of
Sale: |
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Selling
Price:$ |
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Current
Balance:$ |
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Down
Payment:$ |
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Beginning
Balance:$ |
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Date of First
Payment: |
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P/I Payment
Amount:$ |
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Interest:% |
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Payment
Frequency: |
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Next Payment
Due: |
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Original
Term: |
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# of Payments
Paid: |
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# of Payments
Remaining: |
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Is There a
Balloon:? |
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Balloon
Date: |
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Balloon
Amount:$ |
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Payer Qualifications to Operate This
Business: |
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Senior/Junior Lien
Information |
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Will There Be Any Payoffs at
Closing: |
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Do You Owe Money on This
Business:? |
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If So, What Are The
Amounts: |
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Does Your Business Buyer Owe Anyone
Else For The Business Beside
You:? |
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List amounts of any Junior Liens
behind the subject receivables: |
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Description of
Business: |
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Why Are You
Selling:? |
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How Much Immediate Cash Do You
Need:? |
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The data, which we collect from you is not
an application for credit. The intent of this form is for
us to determine if a relationship between DELMarVA Judgment
Services and/or its assigns and you and/or your company would
be mutually beneficial. By submitting the required form, you
authorize DELMarVA Judgment Services and/or its assigns
to access any credit reporting agencies for which we are a
member in your security interest under any agreements and
transactions relating to DELMarVA Judgment Services and you
and/or your firm. Your information is held in
the strictest confidence and is used to help you achieve your
goals in an expeditious and professional
manner.
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Do You Have These Documents? (check all that
apply) |
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Promissory Note: |
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Security Agreement: |
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Title: |
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Sales Contract: |
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Payer Credit Report: |
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Closing Statement: |
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Bill of Sale: |
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Insurance: |
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Lease: |
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Franchise Agreement: |
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UCC-1: |
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