Business name: _________________________________________________________________________

Business address: _______________________________________________________________________

City/St/Zip: _____________________________________________________________________________

Office phone: ________________________________   Fax: ____________________________________

Email: __________________________________   Website: _____________________________________

Seller’s name: __________________________________________________________________________

Home address: _________________________________________________________________________

 

City/St/Zip: _____________________________________________________________________________

Home phone: ____________________________  Cell: _________________________________________

Legal entity form: _______________________________________________________________________

Social security number or federal ID number: _______________________________________________

Direct correspondence to my: __ Office   __ Home  __ Email   __ Other _________________________

Reason for selling:  ______________________________________________________________________

Professional organizations: _______________________________________________________________

Year established: ________  Brief history of Company: _____________________________________________
 

________________________________________________________________________________________

Gross income:  20__ $____________   20__  $_________________   20__  $______________________

Desired asking price: ______________________________________________________________________

Financing terms: __________________________________________________________________________

Estimated value of furniture and equipment: __________________________________________________

Office rent: $ _______________ mo   Sq ft: ___________________   Expiration date: _________________

Office lease assumable:  Yes ______   No ______   Maybe _______

Description of facilities: ____________________________________________________________________