EmailMe Form - CONFIDENTIAL BUYER PROFILE

Name: *

Prefix First Last Suffix

Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone: *

### - ### - ####

Email: *

Confirm Email:

How did you hear about us? *

Have you ever owned a business? *

Yes

No

If so, please describe: *

What kind of work do you currently do? *

Current Income: *

Age: *

Past work experience: *

How soon would you be ready to purchase a business? *

Are you planning on working full time in the business you purchase? *

Yes

No

Cash (not borrowed) available for a down payment: *

Approximate market value of your home: *

Approximate mortgage owed on your home: *

Approximate value of retirement funds, 401K, IRAs, etc.? *

Approximate value of stocks, bonds, and other investments: *

Approximate net worth: *

Approximate amount of credit card debt: *

Minimum amount of income business needs to make including your salary: *

What particular business did you see that interests you? *

Please list other types of businesses you may be interested in: *