Form

Cover Letter
Tell everything you know about the note:*
Broker Information
This section only needs to be completed if a broker is filling out the submission form on behalf of a client.
Broker Name:
First Name Last Name
Broker Company:
Broker Title:

Broker Address:

Broker Number:
- Area Code Phone Number
Broker Fax:
- Area Code Phone Number
Broker E-mail:
Are you in direct contact with the note holder?:
We require that you are in direct communication with the note holder. We do not entertain broker/daisy chains.
Client Contact Information
Client Name:*
First Name Last Name

Client Address:*

Address of Business:*

County:*
How long in business:*
How long at this location:*
Business location is:*
Give Terms of any Lease Renewal Option(s):*
What Qualifications Does the Payor Have to Operate this Business:*
Asset Value Breakdown
Equipment $:*
Inventory $:*
Goodwill $:*
Is Operation a Franchise:*
If Yes, Has Franchiser Committed to Cooperate with Note Buyer in Event of Foreclosure/Resale:
If Payor is a Corporation, Is There Also a Creditworthy Individual Liable for Payments:
If Yes, Name of Individual:
Historical Information
Date of Sale:*
Selling Price:*
Down Payment:*
First Lien:*
Note Information
Date note was created:*
Amount note was created for:*
Term in Months
Amortization:*
Balloon:*
Payment Amount:*
Balloon Amount:*
Balloon Date:*
Interest Rate:*
Due Date of 1st Payment:*
# of Payments Made:*
# of Payments Left:*
Next Payment Due:*
Balance of note:*
Description of Business Location and Area
Tell us what you know about the deal, the business, the Payor, etc.:*
Payor/Payment Information
Employment Info, Payment Record, SSN:*
Motivation Information
Why is the note holder wanting to sell, how fast would they need the money, etc.*
How much do you need to liquidate this note?:*
Do you have the following documents
You will need the following documents ready once an offer is made and accepted.
Note:*
Security Instrument:*
Title:*
Sales Contract:*
Payor Credit Report:*
Closing Statement:*
Bill of Sale:*
Insurance:*
Lease:*
Franchise Agreement:*
UCC-1:*
Enter the code as it is shown:*
Should be Empty:

Cover Letter