FULL NAME *
LEGAL PRACTICE NAME *
WHAT % OF THIS BUSINESS DO YOU OWN *
%
YEARS OF EXPERIENCE AS AN ADVISOR *
OWNER NAME
% OF OWNERSHIP
-+ Additional Partner
HOW MANY YEARS HAVE YOU BEEN WITH YOUR CURRENT FIRM? *
OFFICE PHONE *
MOBILE PHONE *
EMAIL *
BUSINESS ADDRESS *
CITY *
STATE *Select Your StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
ZIP *
HOW MUCH FINANCING ARE YOU APPLYING FOR? ($200,000 MINMUM)
$
PROJECTED CLOSE DATE*
ACQUISITIONPARTNER BUY INPARTNER BUY OUTEQUITY PURCHASEBUSINESS DEBT REFINANCE/CONSOLIDATIONLINE OF CREDITWORKING CAPITAL
Registered Investment AdvisorInvestment Advisor RepresentativeRegistered RepresentativeHybridOSJ
BUYER’S BROKER DEALER
SELLER’S BROKER DEALER
BUYER’S CUSTODIAN
SELLER’S CUSTODIAN
BUYER'S CURRENT AUM *
SELLER'S CURRENT AUM
BUYER’S TRAILING 12 REVENUE *
SELLER'S TRAILING 12 REVENUE
BUYER’S FEE BASED/RECURRING REVENUE? *
SELLER’S FEE BASED/RECURRING REVENUE?
IS THE BUYER’S BUSINESS DEBT FREE? *YesNo
LIST BALANCE OF CURRENT LIABILITIES *
PERSONAL CREDIT SCORE *Select Your Credit Score800+751-800700-750700 or below
ESTIMATED PERSONAL LIQUIDITY *
ESTIMATED QUALIFIED ACCOUNT BALANCES *
ESTIMATED BALANCE OF PERSONAL LIABILITIES *
ESTIMATED NET WORTH INCLUDING BUSINESS *
ESTIMATED NET WORTH EXCLUDING BUSINESS *
Are you in good standing with FINRA and/or SEC? *
YesNo
Have you ever filed for or taken bankruptcy, composition / settlement / assignment for benefit of creditors, or had a short sale of real estate or other property? *
Do you have any tax liens or contested taxes ? *
Have you been a party to a foreclosure, repossession, debt settlement and/or short sale proceeding?*
Have you been charged or convicted of a felony ? *
Are you or have you ever been a defendant in any suits or legal actions?*
Have you ever been charged with, arrested, convicted, placed on pre-trial diversion, or placed on any form of probation, including adjudication withheld pending probation for any criminal offense other than a minor vehicle violation? Include DUI and DWI offenses and those which have been dismissed, discharged, or not prosecuted. *
FULL NAME
PHONE
EMAIL
BUSINESS ADDRESS
PERSONAL CREDIT SCORESelect Your Credit Score800+751-800700-750700 or below
ESTIMATED PERSONAL LIQUIDITY
ESTIMATED QUALIFIED ACCOUNT BALANCES
ESTIMATED BALANCE OF PERSONAL LIABILITIES
ESTIMATED NET WORTH INCLUDING BUSINESS
ESTIMATED NET WORTH EXCLUDING BUSINESS
Are you in good standing with FINRA and/or SEC?
Have you ever filed for or taken bankruptcy,composition / settlement / assignment for benefit of creditors, or had a short sale of real estate or other property?
Do you have any tax liens or contested taxes ?
Have you been a party to a foreclosure, repossession, debt settlement and/or short sale proceeding?
Have you been charged or convicted of a felony ?
Are you or have you ever been a defendant in any suits or legal actions?
Have you ever been charged with, arrested, convicted, placed on pre-trial diversion, or placed on any form of probation, including adjudication withheld pending probation for any criminal offense other than a minor vehicle violation? Include DUI and DWI offenses and those which have been dismissed, discharged, or not prosecuted.
HOW DID YOU HEAR ABOUT US?
