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.

Name*
First Last
Business Phone*
Home Phone
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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)
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 counted toward total income.
Section 2. Loans payable to banks and others
Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.
Upload a document with the following:
- Name and address of noteholder(s)
- Original balance
- Current balance
- Payment amount
- Frequency (monthly, etc)
- How secured or endorsed type of collateral or applicable
Upload Document
Accepted file types: doc, pdf, Max. file size: 50 MB.
Section 3. Stocks and Bonds
Upload a document with the following:
- Number of shares
- Name of securities
- Cost
- Market value quotation/exchange
- Date of quotation/exchange
- Total value
Upload Document
Accepted file types: doc, pdf, Max. file size: 50 MB.
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.
Upload a document with the following:
- Type of property
- Address
- Date purchased
- Original Cost
- Present market value
- Name of mortgage holder
- Mortgage balance
- Amount of payment per month/year
- Status of mortgage
Upload Document
Accepted file types: doc, pdf, Max. file size: 50 MB.
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
Signature
Date

34977

Sell My Business Registration Form

Assets

Liabilities

Section 1. Source of Income

Contingent Liabilities

Section 2. Loans payable to banks and others

Section 3. Stocks and Bonds

Section 4. Real estate owned

Section 5. Other personal property and other assets

Section 6. Unpaid taxes

Section 7. Other liabilities

Section 8. Life insurance held

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