KELLER WILLIAMS CHECK REALTY
BUSINESS BROKERAGE

SELLERS PERSONAL INFORMATION FORM

       Please fill out the following form and upon completion mail to ERA National Realty of Arizona,
Business Brokerage at the address listed at the end of this form.
 This form will remain strictly confidential and will not be released, sold,
rented or licensed to any third party without your consent.
 

First Name               Last Name       

E-mail Address:  

Street Address:   City: State: State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Colombia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina north Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip:

Home Phone #:        Work Phone #           Fax Number:     

Owner's Interview Information
 

Please complete the below listed questions by selecting the answer that best describes your business. 
Your participation in fully answering the questions can save you money and help us serve you better.

Do you use an accountant to prepare your financial reports?                                                           YES       NO    

Can you provide financial reports to include P&L statement, Balance Sheet and                           YES       NO  
Federal Tax Return for the last three budget years?

Can you provide a current Profit and Loss Statement and Balance Sheet for the current year?    YES       NO 

How many years have you owned your business?                                                                Number of Years Less than 1 Year Less than 3 Years 3 to 5 Years 5 to 10 Years 10 + years

How many years has the business operated using the current name & location?              Number of Years Less than 1 Year Less than 3 Years 3 to 5 Years 5 to 10 Years 10 + years

What is the competitive situation in your market area for similar businesses?                  Competition None Light Typical Heavy Saturated

What do you think your competitive ranking is in your market area?                              Ranking One1 Top Three Top Five Top Ten

What is the total Sales Revenue for last year?                                                                Less than $50,000 Less than $100,000 $100,000+ to $200,000 $200,000+ to $400,000 $400,000+ to $600,000 $600,000+ to $800,000 $800,000+ to $1,000,000 $1,000,000 to $2,000,000 $2,000,000 +

What is the trend of the Sales Revenue over the last Three Years?                             Sales Trend Strongly Up Moderatly Up Flat Up and Down Moderatly Down Strongly Down                 

Have you had a formal Business Valuation in the last 12 months?                                  YES       NO 

In cash and benefits, what was the total compensation to the owners that was                   Owner Cash Benefit less than $40,000 $40,000+ to $75,000 $75,000+ to $100,000 $100,000+ to $150,000 $150,000+ to $250,000 $250,000+ to $500,000 $500,000 +
taken from the business last year?

What would you estimate the total compensation to a new owner will be?                          New Owner Cash Benefit less than $40,000 $40,000+ to $75,000 $75,000+ to $100,000 $100,000+ to $150,000 $150,000+ to $250,000 $250,000+ to $500,000 $500,000 +
Factor in payments to employees that might be necessary if one person
can't cover all the tasks now performed by current owner?

What is the trend of the total compensation to owners over the last three years?          Compensation Trend Strongly Up Moderatly Up Flat Up and Down Moderatly Down Strongly Down

How is the total compensation to owners this year compared to last year?                                                  Last Year Comp. Much More More Same Less Much Less

How much revenue growth is realistically possible over the next two years if the           Revenue Growth? Unknown 1% to 10% 11% to 20% 21% to 30% 31% to 40% 41% to 50% 50% +
new owner were to invest some money into growth?

How much money would you estimate that the new owner would need to invest              New Owner Investment? Unknown 1% to 10% 11% to 20% 21% to 30% 31% to 40% 41% to 50% 50% +
to achieve that potential growth? (select your percentage based upon gross
income for last year)

What is the most important competitive advantage that your business enjoys                          Advantage None Excellent Location Patents 1st In Market Best Pricing Other Exclusive products
and can sustain?

Are there human resources or suppliers, critical to the business, not easily replaced?    YES              NO

How suitable is the current facility and location for future company use?                                                      Suitable Use Suitable Use Too Expensive Future_Use Good Growth Capability At Capacity Now Currently Cramped Must Expand

How expensive would it be for a new competitor to get into this type of business?
 

How would you describe the new owner's role, other than normal ownership responsibilities?
 

How would you describe the eye appeal of your business?
 

Is the current workforce able to continue day-to-day operations without the current owner?   Yes           No

 On average, how many hours per week are you applying to the business?             

How many hours per week will a new owner need to apply to the business              
after they have settled into the business?
   
How long will it take a new owner to ramp up to effectively run this business?        

How difficult is it to find a person with necessary skills needed to be the new owner of this business?
 

GENERAL INFORMATION ABOUT YOUR BUSINESS

What do you estimate to be the fair market replacement value of the furniture, fixtures, and equipment (including vehicles) used in operation of the business?

How many square feet of space does your business use?

    Building #1    Square Feet of           leased        owned space.

    Building #2    Square Feet of           leased       owned space.

Is real estate included in the sale?    Yes             No

     If yes, what do you estimate is the market value of the property?     

    If yes, how much land?   acres

In No, what is the current total monthly rent?      

What is the expiration date of your lease?           

Is the Inventory to be included in the sale price? Yes             No

If yes, how much?      If No, approximately how much would the purchaser
                                                                         expect to pay for the Inventory at closing?

Are there any significant intangible or intellectual assets included in the sale?     Yes                 No

     If Yes, the approximate value and description of the assets?    

Is a trade name to be included in the sale?     Yes                 No

    Trade Name?  

The Business is organized as:  

By submitting this form, I confirm that the information provided in this form is correct to the best of my belief and understanding.

Name:        

Title:          

Date:            

WHEN COMPLETE, PLEASE PRINT AND MAIL THIS INFORMATION FORM TO:

GARY VREDEVELD, REALTOR, BBS, CCSS
KELLER WILLIAMS CHECK REALTY
102 N. MONTEZUMA AVENUE
PRESCOTT, AZ. 86301