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Business Funding Intake Form

Please provide the following information so we can better understand your needs.

Business Transaction Intake

Business Name:

State of Incorporation:

Members/Shareholders Information:

Authorized Representative Name:

Email Address:

Phone Number:

Description of Goals:

What is the Name of the Purchaser?

What is the Purchaser’s Address?

What is the Name of the Purchaser’s Authorized Representative?

What is the Target’s Business Name?

Is this an equity or asset purchase?

If purchasing equity, please list the percentage of equity:

If purchasing assets, are you purchasing substantially all assets?

If not, please provide short description of the assets, including contract title if applicable, or name of business division:

Please insert the name of the Bank/Lender.

Please insert the name of the Bank/Lender’s authorized representative.

What is the proposed loan amount?

What is the purchase price?

Please list required equity down payment percentage.

Will the seller finance a portion of the purchase price? If yes, how much?

Please insert the loan term in months or years

Will any portion of the loan term be interest only?

Will there be a fixed interest rate for the entire term of the loan?

If no, please list the period in years or months covering the floating rate period.

Will there be a prepayment penalty?

If yes, please list the percentage of loan paid that triggers the prepayment penalty. Does the percentage of prepayment penalty decrease over time? Please provide any other relevant information.

Will there be collateral given in consideration for the loan? Please list address if the collateral is property and any other relevant information.

Will there be a guarantor? If yes, please list the name of the guarantor.

Is the purchaser required to purchase a life insurance policy?

Please list the amount of the SBA Guaranty Fee in dollars, if applicable.

If yes, please list the policy amount in dollars.

Is there a deposit required? Please list deposit amount.

Business Funding Consultation

Business Funding Intake Form

Business Transaction Intake

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