Pre-Approval Questionnaire

    Contact Information for Primary Borrower/Applicant

    FULL NAME *
    LEGAL PRACTICE NAME *
    WHAT % OF THIS BUSINESS DO YOU OWN *
    %
    YEARS OF EXPERIENCE AS AN ADVISOR *
    ADDITIONAL OWNER NAME AND % OF THE OWNERSHIP
    OWNER NAME
    % OF OWNERSHIP
    %
    OWNER NAME
    % OF OWNERSHIP
    %

    HOW MANY YEARS HAVE YOU BEEN WITH YOUR CURRENT FIRM? *
    OFFICE PHONE *
    MOBILE PHONE *
    EMAIL *
    BUSINESS ADDRESS *
    CITY *
    STATE *
    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)

    ACQUISITIONPARTNER BUY INPARTNER BUY OUTEQUITY PURCHASEBUSINESS DEBT REFINANCE/CONSOLIDATIONLINE OF CREDITWORKING CAPITAL

    PRACTICE TYPE

    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? *
    LIST BALANCE OF CURRENT LIABILITIES *
    $

    Personal Financial Information for Primary Borrower/Applicant

    PERSONAL CREDIT SCORE *
    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? *
    YesNo
    Do you have any tax liens or contested taxes ? *
    YesNo
    Have you been a party to a foreclosure, repossession, debt settlement and/or short sale proceeding?*
    YesNo
    Have you been charged or convicted of a felony ? *
    YesNo
    Are you or have you ever been a defendant in any suits or legal actions?*
    YesNo
    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. *
    YesNo

    Personal Information for Supplementary Borrower(s)

    FULL NAME
    PHONE
    EMAIL
    BUSINESS ADDRESS
    PERSONAL CREDIT SCORE
    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?
    YesNo
    Do you have any tax liens or contested taxes ?
    YesNo
    Have you been a party to a foreclosure, repossession, debt settlement and/or short sale proceeding?
    YesNo
    Have you been charged or convicted of a felony ?
    YesNo
    Are you or have you ever been a defendant in any suits or legal actions?
    YesNo
    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.
    YesNo

    HOW DID YOU HEAR ABOUT US? *
     

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