Business Note Sale Info Form:

1. Please submit all information as completely as possible. Any omissions may result in an adjustment to our quote(s).
2. All quotes are subjcect to underwriting and credit review.
3. We will call you with our quote or to request clarification as necessary.

Your Name (First & Last):
Your Street Address:
Your City: State: Zip Code:
Daytime Phone #: (area code first)
Evening Phone #: (area code first)
Fax Phone #:
Your E-mail Address:

Name of Borrower(s):
Address: City: State:
Zip Code: SSN #: (This is very important for an accurate quote. If you have any questions regarding this, please note below or call us).

The information requested below is the minimum necessary for evaluation of your note.

Original Face Amount: $

Current Balance: $

Interest Rate: % Term:

Monthly Payments: $

Balloon Payment: $ Balloon Date:

Due Date of 1st Pmt:

Total number of payments made to date:

Number of payments left:

Date Next Payment Due:

Are the payments current? - - > Select: Please Select Yes No
Who keeps track of the payments? - - > Select: Please Select Me Loan Servicer Title Company Bank Other

Selling Price: $ Down Payment: $

Sale Date:

Business Location:

Current Value: $

Business Type:

Are the business premises leased? - - > Select: Select YES NO
If the premises are leased, when does the present lease expire?

Position of Note - - > Select : First Second Other

*** If this note is Junior to another loan(s),
what is the approximate balance on the Senior loan(s)? (A) What is the approximate balance on the senior loan(s)? $
(B) What is the approximate monthly payment on the senior loan(s)? $

Your estimated cash requirements: $

( You may not need to sell the entire note... when a partial sale will meet your needs! )

Additional Information / Comments:

Thank you for the opportunity to evaluate your note. We will respond to you shortly!