Welcome to Premium Finance Solutions

www.premiumfinancesolutions.com

Business Note Sale Application Form

CCFC/Broker Information:

Name:

Company:

Address:

City:

State:

Phone:

Fax:

Business Information:

Type of Business:

Location Address:

Country :

City:

State:

ASSET VALUE BREAKDOWN

Equipment : $ Inventory: $ Goodwill: $

How long in business at this location? Is the operation a franchise?

If yes, has franchisor committed to cooperate with note buyer in event of foreclosure/resale?

Business location is: Lease Expires: (dd/mm/yyyy)

Terms of any lease renewal options:

What qualifications does the payor have to operate this business?

If payor is a corporation, is there also a creditworthy individual liable for payments?

If yes, please specify :

Historical Information:

Description of Business Location:

Date of Sale:

Selling Price: $

Down Payment: $

First Lien: $

Second Lien: $

Note Information:

Payor Information:

Date of Note:

(Employment Information, Payment History, SSN)

Amount: $

Term in month:

(a) (b)

Payment Amount: $

Balloon Amount: $

Balloon Date:

Interest Rate: %

Seller's Motivation/Needs:

Due Date 1st pmt:

# of pmts paid:

# of pmts left:

Next pmt due:

Balance: $

Quote:

I have copies of the following:

Buy Total Note: $

Note:

Buy pmts for: $

Security Instrument:

Buy pmts for: $

Title:

Date of Quote:

Sales Contract:

Closing Costs paid by:

Payor Credit Report:

Closing Statement:

Bill of Sale:

Insurance:

Lease:

Franchise Agrmt:

UCC-1:

Premium Finance Solutions, Inc.
1911 Foothill Blvd., #149
La Verne, CA 91750-3511
909-964-1701 Fax: 413-751-9884
E-mail: pfsolutions@adelphia.net
"Insurance Premium Finance & Commercial Lending Solutions"
We are proud to be a member of the American Cash Flow Association.

QUICK LINKS:

• Mission Statement
• Insurance Premium Financing
• Reasons to Sell Cash Flows
• Asset Protection
• Selling Private Mortgage Notes
• Receivable Funding/Factoring
• Structured Settlements
• Leasing
• Apply Online