Secure Business Note Submission Form
Donald Jeffery & Co., LLC
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What is your role in this submission ?
*
Please Select
Noteholder
Business Broker
Other
If other ? Please specify your role from above.
Exact Name of Business (required)
*
Include, ie: Inc. LLC. LP. LLP. LTD etc.. Extensions if applicable.
Type of Business
*
Business’ Website
Business’ Address - Country
Business’ Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Location is Owned or Leased ?
*
Please Select
Owned
Leased
If leased, expiration date:
Is Note personally guaranteed ?
*
Please Select
Yes
No
Selling Price
*
Down payment
*
1st Lien
*
2nd Lien
(if applicable)
Date of Note
Starting Balance of Note
*
Original Terms (in mos.)
*
(ie 24, 36, 72, etc..)
Monthly payment amount
*
Balloon Date
(if applicable)
Balloon Amount
(if applicable)
Interest Rate
*
(apr)
Due Date of first monthly payment
-
Month
-
Day
Year
Date
# of monthly payments made
*
# of monthly payments left
*
Next payment due date
*
-
Month
-
Day
Year
Date
Current Balance
*
Description of business and location
*
Payor Information
*
(qualification to operate this business, any outside employment, other relative info)
Why does the Noteholder want to sell ?
*
Upload supporting documents and or images below (optional)
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