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Step 2 of 4

Business Data

Current Position: Self

Company:Position:Duties:Salary / Compensation:

Current Position: Spouse

Company:Position:Duties:Salary / Compensation:

Extra information

Have you ever owned your own business? Give details:How long have you been looking for a business?What other businesses have you investigated?

Preferred Area(s)

Area preferred (city/state):

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Step 3 of 4

Financial Data

Assets

Cash on Hand & in Banks:

Savings Funds/Certificates:

Stocks, Bonds, & Securities:

Retirement Plans, IRA’s, 401Ks:

Home Market Value:

Other Real Estate:

Autos (mkt value):

Insurance Cash Value:

Personal Property:

Other Assets (describe):

Total Assets:

LIABILITIES

Notes Payable:

Revolving A/C Balances:

Charge Card Balances:

Home Mortgage:

Other Real Estate Debt:

Auto Loans:

Other Debts (describe):

Total Liabilities

Net Worth

Net Worth(total assets minus total liabilities)

Extra information

Cash Available for Investment in a Business:If additional funds are needed to start a business, are they available to you?

Do you plan to have a partner?

Do you plan to have investors?

Will either be active in the business?Do you have sources of income other than salary?

FINANCING

The following information is requested because any affirmative answers may have a direct bearing on your ability to obtain financing for starting a new business.

Have you or your spouse ever been involved in a personal or business bankruptcy?Have you or your spouse ever been convicted of a crime?Are you or your spouse currently under any type of criminal investigation?Are you or your spouse currently involved in any pending civil lawsuits?Are you or your spouse subject to any civil judgments?Please explain any affirmative answers to the previous five questions:

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It’s time to be a boss.

Confidential Questionnaire