INFORMATION ABOUT YOU

Name  ____________________________

Date of Birth  ____________________________

Home Address

  ____________________________

  ____________________________

Business Address

  ____________________________

  ____________________________

Home Phone Number   ____________________________

Work Phone Number   ____________________________

Other Phone Number   ____________________________

Facsimile Number   ____________________________

E-mail Address   ____________________________

Web Site Address   ____________________________

INFORMATION ABOUT YOUR BUSINESS PARTNER(S)

(Your business partners, if any, should provide the same information you have provided above)

In addition, if you have business partners, who is expected to initially own the business, in what percentages, and for what contributions?

Percentage of

Owner            Ownership    Contribution

  ________________________________________________

  ________________________________________________

  ________________________________________________

  ________________________________________________

Which of the owners are expected to be employed by the business?   _________________

In what capacities?

  ____________________________

  ____________________________

For what compensation?   ___________________________________________________

Are there any written contracts between you and your business partners, if any?   Yes_______   No______  (If yes, provide your attorney with a copy)

INFORMATION ABOUT MANAGEMENT STRENGTHS AND WEAKNESSES

What strengths do you and your business partners bring to the table that you expect will help make the business a success?

What weaknesses or deficiencies in experience do you and/or your business partners have?

INFORMATION ABOUT THE PROPOSED BUSINESS PURCHASE

Have you investigated or made any determinations as to whether you should structure the business acquisition as an asset purchase, a stock purchase, or a corporate merger?   Yes_______   No______  (If yes, provide details)

Have you taken any steps to incorporate your business?   Yes_______   No______  (If yes, provide details)

Have you retained a broker?   Yes_______   No______  (If yes, provide the broker's name and the terms of the engagement)

Have you been presented with any financial statements, documents describing the business opportunity, or a franchise offering circular?   Yes_______   No______  (If yes, provide your lawyer with a copy)

Have you been presented with or entered into a letter of intent concerning the purchase of the business?   Yes_______   No______  (If yes, provide your lawyer with a copy)

Do you have a written Business Plan?   Yes_______   No______  (If yes, provide your attorney with a copy of it)

Have you offered to sell or sold any interests in your business to any investors?   Yes_______   No______ (If yes, provide details)

Have you obtained or sought to obtain any loans for your business?   Yes_______   No______ (If yes, provide details)

Does the prospective business own or lease any real estate?   Yes_______   No______ (If yes, provide details)

Do you intend to continue operating the business from its present location(s)?   Yes_______   No______

Have you retained any consultants, accountants or tax professionals?   Yes_______   No______ (If yes, provide details)

Have you promised an interest in the company to any consultants?   Yes_______   No______ (If yes, provide details)

OTHER QUESTIONS

(Make a list of other pertinent questions to ask your attorney)