CONFIDENTIAL BUYER QUALIFICATION & PERSONAL INFORMATION SHEET

Thank you for completing this information.  It will help us to better assist you in the acquisition process.  All information you provide is held strictly confidential.

BUSINESS AREA(S) OF INTEREST:  

 ____________________________________________________________________________________________________________

TELL US ABOUT YOU: 

NAME:  ______________________________________________________

 HOME ADDRESS:  _____________________________________________________ HOW LONG? __________________

 CITY/STATE/ZIP:  _____________________________________________________________________________________

 HOME PHONE:  (_______)__________________________                  CELL PHONE:  (_______) ______________________

 WORK PHONE:  (_______)__________________________                  FASCIMILE: (______) _________________________

 HAVE YOU EVER OR DO YOU OWN A BUSINESS(ES) NOW?____YES___/____NO____

 PLEASE DESCRIBE:____________________________________________________________________________________

 ______________________________________________________________________________________________________          

GENERAL INFORMATION:

WILL YOU NEED ASSISTANCE WITH FINANCING?  _________YES____/____NO______________________________

ARE FUNDS AVAILABLE TO YOU IF NEEDED?  ____________YES_____/____NO______________________________

HOW MUCH CASH IS AVAILABLE FOR INJECTION INTO THE BUSINESS?___________________________________

SOURCES OF ADDITIONAL CAPITAL:  __________________________________________________________________

DO YOU PLAN TO PERSONALLY OPERATE THE BUSINESS?  ______________________________________________

ARE YOU APPLYING AS AN INDIVIDUAL, A GROUP, A COMPANY, OR OTHER? _____________________________

WHEN WOULD YOU LIKE TO OPEN YOUR BUSINESS?  ___________________________________________________

DO YOU HAVE ANY BACKGROUND IN MANAGING/OWNING BUSINESS  _____________     IF YES, PLEASE BRIEFLY EXPLAIN:  ___________________________________________________________________________________

______________________________________________________________________________________________________

EMPLOYMENT INFORMATION:

CURRENT EMPLOYER:     _____________________________            POSITION/TITLE:  ___________________________

TYPE OF BUSINESS:  _______________________________                MONTHLY INCOME:  ________________________

ADDRESS:  ___________________________________________________________________________________________

CITY/STATE/ZIP:  _____________________________________________________________________________________