Online Note Request Form

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Seller Financed Business Note Request

	Owner's Name:
	Phone:
	Date:
	E-mail:

	1. Original Selling Price
	2. Down Payment
	3, Original Note Balance
	4. Months Financed
	Interest Rate
	5. Monthly Payment
	6. Balloon:	Yes No
	Date of Balloon:
	Amount of Balloon:
	7. Date of First Payment
	Remaining Balance
	8. Current Balance of Note
	9. Type of Business
	10. How Long in Business
	10. Is Business a Franchise?	Yes No
	If yes, Name of Franchisor
	11. Credit of Payor	Excellent Good Fair Poor Unknown
	12. Does the Business Include Real Estate?	Yes No
	If Yes, R.E Appraised Value
	13. Location of Business
	14. Is Note Personally Guaranteed?	Yes No
	15. Business Description / Address / Additional Comments