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Buyer Registration

This form is also available for Download as PDF, which can be faxed to 260-485-4849.

    General Information

    Name

    Corporate Name

    Address

    Address 2

    Home

    Mobile

    Fax No.

    Email

    Why Do You Want to Buy a Business?

    Background and Experience

    Current Position:

    Will You Be an Active Owner?:
    YesNo

    Absentee Owner?:
    YesNo

    Specific Business Request
    Industry:
    RetailManafacturingDistributionServiceOther

    Preference

    Rank:

    1)

    2)

    3)

    4)

    5)

    NAICS Classification code(s):

    How Soon Do You Wish to Conclude A Business Acquisition?
    Days
    Months

    Preferred Location of Business:

    City
    Miles Radius of City

    Is Your Personal Financial Statement Updated?
    YesNoIf yes, Date of Statement

    How Soon Can You Provide a Copy of the Financial Statement?:

    Amount of Liquid Funds Available for Down Payment:
    $**

    When is the Down Payment Funds Available?:
    **

    Do You Have Assets with Equity to Leverage for Additional Financing if Necessary?:
    YesNo

    Real Estate:
    $
    Equity Value:
    $
    401K:
    $
    Stocks:
    $
    Other:
    $
    Amount of Annual Earnings Required:
    $**
    Return on Investment
    %

    If there are Partners/Investors, Their Names and Involvement are:

    Name:

    1)

    2)

    3)

    Involvement:

    Do You Need any Other Approval(s) to Make the Decision to Purchase?:
    YesNo

    If Yes, What is Their Name and Relationship?:

    Name:

    Relationship:

    If a Bank is Involved, has a Contact Been Made?
    YesNo

    Name of Bank

    Loan Officer:

    Location of Bank:

    Phone #:

    Business Consultants

    Attorney:

    Accountant:

    Firm:

    Firm:

    Note: ** Is a required field, and must be filled in to be accepted as a complete registration with AWBE