Sell My Business Registration Form

In order to best serve your needs, please complete this form and one of our team members will be in touch with you. Your information will be held in the strictest confidence and there is no obligation.

First
Last
Business Phone *
Residence Phone
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Email *
Assets
Omit cents


Cash on hand and in banks
Savings account
IRA or other retirement account
Accounts and notes receivable
Life insurance - cash surrender value only (Complete in Section 8)
Stocks and bonds (Describe in Section 3)
Real estate (Describe in Section 4)
Automobile - Present Value
Other personal property (Describe in Section 5)
Other assets (Describe in Section 5)
Total
Liabilities
Omit cents


Accounts payable
Notes payable to banks and others (Describe in Section 5)
Installment account (Auto)
Monthly payments
Installment account (Other)
Monthly payments
Loan on life insurance
Mortgages on real estate or rent listed per month (Describe in Section 4)
Unpaid taxes (Describe in Section 6)
All other liabilities such as liens, judgments (describe in Section 7)
Total liabilities
Net Worth
Total
Section 1. Source of Income


Salary
Net investment income
Real estate income
Other income (Describe below)
Description of Other Income in Section 1
Contingent Liabilities


As endorser or co-signer
Legal claims and judgments
Other contingent liabilities not listed
Number
Note: Alimony or child support payments do not need to be disclosed in "Other Income" unless it is desired to have such payments sounted toward total income
Section 2. Loans payable to banks and others
Lists loans, mortgage, credit card accounts, and indebtedness. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)


Lists
Name and address of noteholder(s)
Original balance
Current balance
Payment amount
Frequency (monthly, etc)
How secured or endorsed type of collateral or applicable
Section 3. Stocks and Bonds
Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.


Number of shares
Name of securities
Cost
Market value quotation/exchange
Date of quotation/exchange
Total value

Section 4. Real estate owned
List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement and signed.


Type of property
Property A
 
Property B
 
Property C
 
 
 
 
Address
Property A
 
Property B
 
Property C
 
 
 
 
Date purchased
Property A
 
Property B
 
Property C
 
 
 
 
Original Cost
Property A
 
Property B
 
Property C
 
 
 
 
Present market value
Property A
 
Property B
 
Property C
 
 
 
 
Name of mortgage holder
Property A
 
Property B
 
Property C
 
 
 
 
Mortgage balance
Property A
 
Property B
 
Property C
 
 
 
 
Amount of payment per month/year
Property A
 
Property B
 
Property C
 
 
 
 
Status of mortgage
Property A
 
Property B
 
Property C
 
 
 
 
Section 5. Other personal property and other assets
Describe, and if any is pledged as security, state, name, and address of lien holder, amount of lien, terms of payment and if delinquent, describe delinquency


 
Section 6. Unpaid taxes
Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches


 
Section 7. Other liabilities
Describe in detail


 
Section 8. Life insurance held
Give face amount and cash surrender value of policies - and name of insurance company


 
I hereby affirm that this personal financial statement contains no willful misrepresentation or falsifications and this information given by me/us is true and complete to the best of my/our knowledge and belief
Signature
Date
Month
 
Day
 
Year
Signature
Date
Month
 
Day
 
Year
Security Check: Please solve the simple math question to continue *
37 + = 46

Menu