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[PLEASE PRINT FORM AND SEND U.S. MAIL or FAX 978-663-0061] ACORP BIZNESS NETWORK — QUESTIONNAIRE (sole proprietorship) (Attachment to Broker Agreement dated _______) BUSINESS NAME: __________________________________________________________ ADDRESS: ________________________________________________________________ 1. ENCUMBRANCES__________________________________________________________ Existing Business Encumbrances? ______________________________________________ Existing Real Property Encumbrances? ___________________________________________ __________________________________________________________________________ 2. PROPERTY LEASING INFORMATION Are Business Premises Owned or Leased? _________________________________________ Lessee Name? _______________________________________________________________ Lessor/Property Owners? ______________________________________________________ Premises Zoning? _______ Lease Period? ____________________ Options? ___________________________________ Monthly Rent? _________________________ Deposits? _____________________________ 3. How long has Business been in operation? _____________________ By Seller? _________ 4. Is Business a corporation? _________ Sole proprietorship? _________ Partnership? ______ If incorporated what State and when? State _________________ When? ______________________ If incorporated is a corporate stock or corporate asset being sold? ______________________ 5. No. of employees (owners(s)) ___________________ Full time _________Part time ______ 6. Month accounting year ends? __________ Days Open? ___________ Hours? ____________ 7. What is Seller’s reason for selling? ______________________________________________ 8. Will Seller train buyer? Yes ______ No ______ for how long without pay? ________________ 9. What will the monthly debt service payment be if the business is sold as listed? ___________ 10. Is any equipment under rental or lease agreement? (describe) _______________________ ___________________________________________________________________________ 11. Will books and records verify sales figures and profits quoted? _______________________ 12. Is Business listed with any other Broker? Yes ________ No _________ Who? __________ 13. How much inventory at cost will be transferred with Business? _______________________ 14. Is this inventory included in the total price? ____________________ 15. What is the approximate replacement value (in its present condition) of all equipment included in the assets for sale? ____________________________________________________________ 16. To the best of Seller’s knowledge are there any legal actions pending or threatened against the Business? Yes _________ No _________ describe ___________________________________ 17. Are there any special licenses required other than normal i.e. sales tax? _____________________ ____________________________________________________________________________ REMARKS AND COMMENTS _______________________________________________________ ____________________________________________________________________________
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