Business Note Request Form Please enable JavaScript in your browser to complete this form.Note Holder's Name *Note Holder's Email Address *Note Holder's Phone Number *How Should We Respond to You?Please Call MePlease Email MeNo Preference – Either WayNote Payor's Name *Note Payor's Email Address *Payor's Credit if KnownExellentGoodFairPoorUnknownIs Payor in the Armed Forces?YesNoIf Payor is in the Armed Forces, Are They Deployed?YesNoBusiness Information WorksheetName of Business *Type of BusinessBusiness Address *City, State, Zip *Business Sales Price *Business Sale Down Payment *Business Appraised ValueAppraisal DateBusiness Annual RevenueBusiness Annual ExpensesBusiness Net Operating IncomeYears in BusinessDate Business Was SoldIs Business a FranchiseYesNoIs Business Location Leased?YesNoIf Leased, Explain Lease Renewal OptionsBusiness Asset Valuation SummaryBusiness Equipment ValueBusiness Inventory ValueBusiness Leasehold Improvements ValueBusiness Goodwill ValueReal Estate FMV if Bus. Property is OwnedAdditional Collateral? Please Explain. Are any of the Listed Assets Encumbered?YesNoAre There Any UCC-1 Security Filings?YesNoIf Yes, What Was the Date of Filing?If Yes, Who is the Secured Party?Business Promissory Note WorksheetNote's Lien Position *First SecondNote's Interest Rate is… *Fixed RateVariable RateIs the Note Current? *YesNoOriginal Note Balance *Term of Note *Note Monthly Payment *Note Interest Rate *First Payment DateNumber of Payments Made to DateNumber of Payments RemainingCurrent Note BalanceIs There a Balloon?YesNoIf Yes, Date Balloon DueIf Yes, Balloon Amount DueIs There a Personal Guarantor?YesNoIf so, Guarantor's NameAdditional Business Quote Request InformationPlease Do the Math *What is 13-4? Submit
