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Buyer Registration

General Information:   Name: ** A value is required.A value is required.  Corporate Name:   Address: ** A value is required.A value is required. Address Line 2: Home: ** A value is required.A value is required. Mobile: ** A value is required.A value is required. Fax No: A value is required.A value is required. Email: ** A value is required.A value is required. Why Do You Want to Buy a Business?: Background & Experience: Current Position: A value is required. Background & Experience: A value is required. Will You Be an Active Owner?: Yes   l   No  Absentee Owner?: Yes   l   No      Specific Business Request   Industry:  Retail Manufacturing    Distribution    Service       Other   Preference   Rank: NAICS Classification code(s) 1) 2) 3) 4) 5)     How Soon Do You Wish to Conclude A Business Acquisition?:   A value is required.Days A value is required.Months       Preferred Location of Business: A value is required.City A value is required.Miles Radius of City Is Your Personal Financial Statement Updated? Yes  l  No  If Yes, Date of statement     How Soon Can You Provide a Copy of the Financial Statement?: A value is required. Amount of Liquid Funds Available for Down Payment: A value is required.A value is required.** When is the Down Payment Funds Available?: A value is required.A value is required.**     Do You Have Assets with Equity to Leverage for Additional Financing if Necessary?: Yes   l   No          Real Estate: $ Equity Value: $ 401K: $ Stocks: $ Other: $   Amount of Annual Earnings Required: $ **A value is required.A value is required. Return on Investment A value is required.A value is required.%    Are There Partners/Investors? Provide Their Names and Level of Involvement:   Name: Involvement: 1) 2) 3)     Do You Need any Other Approval(s) to Make the Decision to Purchase?: Yes   l   No    If Yes, What is Their Name and Relationship?:   Name: Relationship:     If a Bank is Involved, has a Contact Been Made? Yes   l  No  Name of Bank: Loan Officer: Location of Bank: Phone #:             Business Consultants:   Attorney: Firm: Accountant: Firm:

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