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This first section to be completed by submitting Member |
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| Member Company Name : |
| Member Company Address : |
| City_____________________ State
__________Zip Code ____________________ |
| Contact Name _______________________
Title------------------------- |
| Contact Number ____________________ Fax
Number :______________________ |
| Email Address : |
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| The remainder of this
worksheet is to be completed and signed by BORROWER |
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| Purchase Price of
Business $
___________ |
Seller Note (if any) $______________ |
| Cash Equity
from Buyer $ ___________ |
Loan Request $___________________ |
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Personal Credit Scores of Buyer(s) |
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Is Buyer an Operating Company
or an Individual? |
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Does buyer have direct
experience with respect to the type of business being acquired and if so
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for how long?________________ |
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The remainder of this worksheet is in
reference to the company to be acquired: |
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What does this company do?
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Manufacturer |
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Wholesale/Distributor |
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Retailer |
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Service Business |
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Briefly describe the nature of the business- |
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Company to be purchased is
located in what City/Town and state |
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Town/City:_____________________ State: ____________________ |
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Acquisition of Operating Company |
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Year Company Began |
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How much is typical month sales
other than gasoline, lottery, bill pay, check cash |
$ |
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How many gallons per month
sales (average of 12 months) |
$ |
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How much is lottery commission
last year |
$ |
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How much is ATM average per
month income |
$ |
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Is the ATM machine owned by any
third party: |
Yes___________ No___________ |
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Total Accounts Receivable Now |
$ |
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Accounts Receivable over 90
days old |
$ |
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Total Accounts Payable over
90 days old |
$ |
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Credit terms extended by the
Seller "Note" |
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Is the business seasonal? |
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What is current company net
worth |
$ |
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Estimate the
liquidation value of the company inventory (exclude work in progress) |
$ |
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Estimate the
value of the equipment if it were liquidated |
$ |
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(Note- furniture and telephone/computer
equipment is not acceptable collateral) |
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If equipment has been appraised, for how much,
what type appraisal (FMV, OLV, FLV, etc.) and when? |
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Appraised/estimated value of business owned
Real Estate |
$ |
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Estimated value
of any other business assets |
$ |
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Total secured debt against
company now |
$ |
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Does any customer account for
more than 25% of A/R? |
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2024 Revenue $
__________________ |
2024 net income $
__________________ |
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2023 Revenue $
__________________ |
2023 net income $
__________________ |
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2022 Revenue $
__________________ |
2022 net income $
__________________ |
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This Years Projected Sales
Volume |
$ |
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Currently making or losing
money? |
Yes_____ No _______ |
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If making money for how many
consecutive months? |
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Does Company have there
accountant prepared financial statements? |
Yes____ No ____ |
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If so, when does the accounting
year end? |
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What type statement (audited,
reviewed, compiled) |
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Additional Comments, if any: |
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Signature of authorized representative:______________________________________________ |
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Print Name
____________________________Title:________________ Date:
_____________ |
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