Part 1 of Selling your Business.

Part 1 - Seller Information
(For a printable version of this form, click right here)

Company Information:
Legal Name of Business for Sale:
Business Address:
City: State: Zip:
Counties you operate in:

Alternate Address:
Address:
City: State: Zip:
Direct all Mail To:	Business Address Alternate Home Address

Contact Information:
Business Phone Number:
Fax Number:
Cell Phone Number:
Pager:
Home Phone Number:
Home Fax Number:
Business Email Address:
Home Email Address:
Your Website:

Legal Information:
Representative's Capacity: (Owner, President, or Other Representative)
Legal Name, Seller:
Social Security Number:
Legal Name, Spouse:
Social Security Number, Spouse:
Type of Business:	Partnership Sole Proprietorship Corporation "S" "C" "LLC"
Federal Employer Identification Number (FEI #)
License Required:	City State Sales Tax Other:
Do you have a Dunn and Bradstreet Rating, if so what is it?
May we Contact Dunn and Bradstreet for your Rating?	Yes No

Sale Price of the Business:
(A). Purchase Price:
(B). Down Payment:
(C). Includes $ Commission / 10 % Of the Sale Price of the Business.
(D). Seller will carry a Secure Promissory Note for $ at % Interest.
(E). Additional Terms:

A + Business Brokers, Inc.
17193 NW 242nd STREET
High Springs, FL 32643
1-386-454-3333/FAX: 1- 386-454-4522

Broker:

Schedule A, B, and C are part of the listing agreement on Part IV. Completing this information does not obligate you to a listing, but we do need this information to determine a selling price of your business.

SCHEDULE "A"

14. Data from the portfolio checklist information and any financial information is called Schedule "A"

Check here is there is additional information attached from other sources..

A. Three years Federal Tax Returns. Mail FedEx
B. Company Financial Information for this Fiscal Year. Mail FedEx
C. Name of Bank where you do Business:
D. Any other Financial Information you wish to supply:

SCHEDULE "B"

15. Information from this checklist, all equipment, fixtures, and all other items included in the sale is called "Schedule "B."

A. List of all equipment, including office equipment, that will go with the business (See Appraisal, if one)

Check here if there is additional information attached from other sources.

Description of Equipment

Serial Number:

Current Value Today:

Name: Serial # Current Value:

(Computer Print Out).

B. List of all Vehicles, Trailers or other Mobile Equipment (See Appraisal)

(Computer Print Out).

C. List of all Accounts (At Closing).

(Computer Print Out).

D. List of Accounts Receivable, if any. (at Closing).

(Computer Print Out).

SCHEDULE "C"

16. A formal written Business Appraisal, if there is one, is called Schedule "C."

Check here if there is not an Appraisal.

(This will erase all the data, that hasn't been submitted yet)