Name: (please print) ______________________________________________________
Phone: (home) _____________________ (work) _______________________________
Phone: (Cell) _______________(e-mail) ____________________(fax) ______________
Address: _______________________________________________________________
City: ______________________________________State: ________ Zip: ____________
Present Occupation: ______________________________________________________
Marital Status: _____________________
Reason for acquiring a business:_____________________________________________
_______________________________________________________________________
Have you ever owned a business before? ______________________________________
If so, what type? _______________________________________________________________________
Desired date to take possession: _______________________________________________________________________
Preferred Location: _______________________________________________________________________
Type of business preferred (1) _______________________________________________
(2) ____________________________________ (3) ______________________________
How long have you been looking for a business? ___________
Prior business experience and education: ______________________________________
_______________________________________________________________________
Will anyone else assist you in operating the business or help in the acquisition decision? _______________________________________________________________________
If so, what is their relationship? ______________________________________________
How did you learn of our services? ___________________________________________
Financial Summary: (Please complete the Confidential Personal Financial Statement)
How much have you allocated for a down payment?
Minimum: $_________________________ Maximum: $______________________
How much have you allocated for working capital requirements? ______________
Your present Net Worth: ____________________________________________________
What is the source of your down payment?______________________________________
Is your down payment available today? ___________________ If not, when? ______
What is your present salary?_________________________________________________
What are your expected income needs?________________________________________
Would you borrow against your home equity to purchase a business?_________________
Affiliated Business Brokers, Inc.
Colorado Springs, CO 80906

719-540-9666 Fax