Personal Information

Contact Person:

Email:

Phone:

Fax:

Project:
(For easy identification please insert a title for your project.  Example: "Sunset Cleaners" or "Rainbow Printing".)

Project Information

Original Selling Price:

Down Payment:

Original Note Balance:

Months / Years Financed:

Interest Rate:

Monthly Payment:

Balloon:

   Yes   No

if yes, date:

Amount:

Date of First Payment:

Remaining Payment:

Current Balance:

Credit of Payer:

Type of Business:

How Long in Business:

Is Operation a Franchise:

   Yes   No

Is Note Personally Guaranteed:

   Yes   No

Location of Business:

Comments: