Pre-Approval Questionnaire

FULL NAME ^*

LEGAL PRACTICE NAME ^*

WHAT % OF THIS BUSINESS DO YOU OWN ^*

%

YEARS OF EXPERIENCE AS AN ADVISOR ^*

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 ^*

Practice & Transaction Information

HOW MUCH FINANCING ARE YOU APPLYING FOR? ($200,000 MINMUM)

$

PROJECTED CLOSE DATE^*

WHAT TYPE OF LOAN ARE YOU APPLYING FOR?(CHECK ALL THAT APPLY)

PRACTICE TYPE

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

Personal Financial Information for Primary Borrower/Applicant

Personal Information for Supplementary Borrower(s)

HOW DID YOU HEAR ABOUT US? ^*