First Name * Last Name * Email Address * Phone Number * Property Information Exact Business Name * Type of Business Asset Value Breakdown Equipment Inventory Goodwill Additional Collateral and its Value: Was there a signed Security Agreement with UCC-1 recorded at the time of note creation? Yes No Annual Revenue of Business: Annual Net Operating Income: Is operation a franchise? Yes No Street Address City State Please select an option AL AK AZ CA CO CT DE DC FL GA HI ID IL IN IA LA KS KY MA MD ME MI MN MO MS MT NC ND NE NH NM NJ NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code How many years in business at this location? * Business Location is: Owned by Payor Leased by Payor Qualifications of Payor to operate this business: * Is the Note personally guaranteed? Yes No HISTORICAL INFORMATION Date of Sale Selling Price: Down Payment: Are there any liens or underlying loans agains the business? (SBA, other bank, etc.) Yes No Note Information Original Note Amount: Term in months: Payment Amount: Balloon Amount: Balloon Due Date: Interest Rate: Due Date of First Payment: Number of payments made: Number of payments left: Next payment due date: Current Balance: Why do you want to sell the note? Other comments: How did you hear about Seascape Capital? Please select one Referred by another person Google search Bing or Yahoo search Other
