Business Note Submission Worksheet

Business Information

Name

Type of business

Street Address

City    State    Zip

Phone   Fax   Email

Asset Value Breakdown

Equipment   $   Inventory  $    Goodwill   $

How long in Business at this location?   Is the operation a franchise?   Yes    No

If yes, has franchisor committed to cooperate with note buyer in event of foreclosure/resale?

yes     No

business location is     Owned by payor    leased by payor   Lease Expires
Terms of lease renewal options

What qualifications does payor have to operate business?

If payor is a corporation, is there also a creditworthy individual liable for payments?

Yes        No     Name

Historical Information                                                    

Date of Sale                                
Selling Price                                 
Down Payment                             
First Lien                                     
Second lien                                  

Note Information                                                                                                                                        

Date of Note                              
Amount                                      
Term in Months                          
Payment Amount                   
Balloon Amount                           
Balloon Date                               
Interest Rate                             
Due Date 1st PMT                      
# of pmts paid                           
# of pmts left                               
Next pmt due                             
Balance                                      
                                                                          
                                                                                      

Payor Information                                                                      

Employment Info.

Payment History

Social Security Number

I have Copies of the Following:

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

Prior Mortgage Info.                Yes    No

Seller,s Motivation/Need