Pre-Approval Questionnaire

    Contact Information for Primary Borrower/Applicant

    FULL NAME *

    LEGAL PRACTICE NAME *

    WHAT % OF THIS BUSINESS DO YOU OWN *

    %

    YEARS OF EXPERIENCE AS AN ADVISOR *

    ADDITIONAL OWNER NAME AND % OF THE OWNERSHIP

    OWNER NAME

    % OF OWNERSHIP

    %

    OWNER NAME

    % OF OWNERSHIP

    %

    HOW MANY YEARS HAVE YOU BEEN WITH YOUR CURRENT FIRM? *

    OFFICE PHONE *

    MOBILE PHONE *

    EMAIL *

    BUSINESS ADDRESS *

    CITY *

    STATE *

    ZIP *

    Practice & Transaction Information

    HOW MUCH FINANCING ARE YOU APPLYING FOR? ($200,000 MINMUM)

    $

    PROJECTED CLOSE DATE*

    WHAT TYPE OF LOAN ARE YOU APPLYING FOR?(CHECK ALL THAT APPLY)

    ACQUISITIONPARTNER BUY INPARTNER BUY OUTEQUITY PURCHASEBUSINESS DEBT REFINANCE/CONSOLIDATIONLINE OF CREDITWORKING CAPITAL

    PRACTICE TYPE

    Registered Investment AdvisorInvestment Advisor RepresentativeRegistered RepresentativeHybridOSJ

    BUYER’S BROKER DEALER

    SELLER’S BROKER DEALER

    BUYER’S CUSTODIAN

    SELLER’S CUSTODIAN

    BUYER'S CURRENT AUM *

    $

    SELLER'S CURRENT AUM

    $

    BUYER’S TRAILING 12 REVENUE *

    $

    SELLER'S TRAILING 12 REVENUE

    $

    BUYER’S FEE BASED/RECURRING REVENUE? *

    $

    SELLER’S FEE BASED/RECURRING REVENUE?

    $

    IS THE BUYER’S BUSINESS DEBT FREE? *

    LIST BALANCE OF CURRENT LIABILITIES *

    $

    Personal Financial Information for Primary Borrower/Applicant

    PERSONAL CREDIT SCORE *

    ESTIMATED PERSONAL LIQUIDITY *

    $

    ESTIMATED QUALIFIED ACCOUNT BALANCES *

    $

    ESTIMATED BALANCE OF PERSONAL LIABILITIES *

    $

    ESTIMATED NET WORTH INCLUDING BUSINESS *

    $

    ESTIMATED NET WORTH EXCLUDING BUSINESS *

    $

    Are you in good standing with FINRA and/or SEC? *

    YesNo

    Have you ever filed for or taken bankruptcy,
    composition/settlement/assignment for benefit of creditors, or had a short
    sale of real estate or other property? *

    YesNo

    Do you have any tax liens or contested taxes ? *

    YesNo

    Have you been a party to a foreclosure, repossession, debt settlement and/or short sale proceeding?*

    YesNo

    Have you been charged or convicted of a felony ? *

    YesNo

    Are you or have you ever been a defendant in any suits or legal actions?*

    YesNo

    Have you ever been charged with, arrested, convicted, placed on
    pre-trial diversion, or placed on any form of probation, including
    adjudication withheld pending probation for any criminal offense
    other than a minor vehicle violation? Include DUI and DWI offenses
    and those which have been dismissed, discharged, or not
    prosecuted. *

    YesNo

    Personal Information for Supplementary Borrower(s)

    FULL NAME

    PHONE

    EMAIL

    BUSINESS ADDRESS

    PERSONAL CREDIT SCORE

    ESTIMATED PERSONAL LIQUIDITY

    $

    ESTIMATED QUALIFIED ACCOUNT BALANCES

    $

    ESTIMATED BALANCE OF PERSONAL LIABILITIES

    $

    ESTIMATED NET WORTH INCLUDING BUSINESS

    $

    ESTIMATED NET WORTH EXCLUDING BUSINESS

    $

    Are you in good standing with FINRA and/or SEC?

    YesNo

    Have you ever filed for or taken bankruptcy,
    composition/settlement/assignment for benefit of creditors, or had a short
    sale of real estate or other property?

    YesNo

    Do you have any tax liens or contested taxes ?

    YesNo

    Have you been a party to a foreclosure, repossession, debt settlement and/or short sale proceeding?

    YesNo

    Have you been charged or convicted of a felony ?

    YesNo

    Are you or have you ever been a defendant in any suits or legal actions?

    YesNo

    Have you ever been charged with, arrested, convicted, placed on
    pre-trial diversion, or placed on any form of probation, including
    adjudication withheld pending probation for any criminal offense
    other than a minor vehicle violation? Include DUI and DWI offenses
    and those which have been dismissed, discharged, or not
    prosecuted.

    YesNo

    HOW DID YOU HEAR ABOUT US? *

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