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INFORMATION INTAKE FORM
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Property Type: Property Sub Type:
Owner 1 *: Email *:
Owner 2: Email:
Owner 3: Email:
Owner 4: Email:
Owner 5: Email:
More Owners Less Owners
Business Legal Name *: DBA:
Address: Make Address Confidential
City: State:
County: Zip:
Select state first...
Tel: Fax:
Website:
Description:
Asking Price: FF&E:
GOI: NOI:
EBITDA:
Inventory Included in Price: Yes No Estimated Inventory:
Franchise Y/N: Yes No Franchise Transfer Fee:
Company Type: Individual(s) A Partnership A Corporation An LLC An LLP Other
Ownership Type: Own Rent Lease Sub Lease Under Contract to Own
Investment Highlights Pro's and Con's
Training/Support Expansion Potential
Competition / Market Reason for Sale
Year Established Home Based Relocatable Lease: Options:
Absentee owner operation Owner operated Semi-absentee owner
Security System Multiple Locations Experience Necessary
Additional fields…
House Type: Tax Assessed Value: Annual Tax Amount:
HOA Fees: Home Owners Insurance: Utilities Estimate:
Bedrooms: Full Bathrooms: 3/4 Bathrooms:
1/2 Bathrooms: 1/4 Bathrooms:
Other Rooms:
Flooring: Heating: Cooling:
Appliances: Interior Features: Exterior Features:
Amenities: Foundation Material: Roofing Material:
Last Sold:
Nearby Schools:
Sales/Income:
Annual Taxable Sales:
Annual Non-Tax Sales:
Annual Other Income:
Annual Rental Income:
Lotto:
Cigarette Sales:
Grocery Sales:
Liquor Sales:
Check Cashing:
Food Sale:
Catering:
Parties:
Dine-In:
Bar Sales:
Avg Rent / Unit:
Premium:
Premium Markup:
Regular:
Regular Markup:
Unleaded:
Unleaded Markup:
Diesel:
Diesel Markup:
Other:
Other Markup:
Car Wash:
Car Wash Ann Rvn:
Has Market:
Market Ann Rvn:
Has Restaurant:
Restaurant Ann Rvn:
Ann Grs Revenue:
Annual Net Profit:
**Ann Rvn: Annual Revenue
**Ann Grs Revenue: Annual Gross Revenue
Expense:
Rent: Payroll: Utilities: COG: Misc:
Full Time Employees: Part Time Employees: Managers:
NNN: Insurance: Advertising:
Please list any other specifics about your business that we should know:
Additional Information
Additional Information
Non Manager: Yes No
Electric:
Lot SQ:
Air Rights
Royalties: Trading Hours
Amenities & Sevices Insurances Accepted
Keys Beds Rooms
Buildings Units Stories
Year Built Year Renovated
Parking Spaces Parking Type Pemitted Zoning
Tenancy Occupied Number of Tenants
Dining Seats Bar Seats Patio Seats
Number of Vehicles Number of Bays Living Accomodation
Ceiling Height
Hair Stations Nail Stations Pedicure Stations
Tanning Stations Spray Tanning Units Massage Stations
Break room Conference room Training Room
Waiting Room Front desk Laboratories
X-ray room Nursing station Doctors office
Exam Rooms Consultation room Private office
Sterilization room Operatories Operating Room
Recovery Room Preoperative area Doctors lounge
Nurses lounge Therapy room Chart Room
Supply Room Private workout suites Offices
Restrooms Elevator Virtual Offices
Apartments Cabins Condos
Rv parking Spaces Campsite
Sauna Steam Room Jacuzzi
Manicure Pedicure Massage
Facials Waxing Tanning
Make-up Cool Sculpting Laser
Skin tightening Laser Hair Removal Cryotherapy
Infrared Therapy Botox Fillers
Hydration Therapy Medical Weight-loss Hormone Replacement Therapy
Collagen Induction Therapy Microneedle Radio-frequency
Revepeel Dermapeel Dermaplaning
Microabrasion facial LED bed Ultra Sound
Stem cell treatment Ozone therapy Hydrotherapy
24-hour physician and nursing services Physical Therapy Aquatic therapy
Speech/language pathology Occupational therapy Clinical lab services
Dietary services Pharmacy Respite care available
Transportation to medical appointments and activities Podiatry services Licensed social worker
Activities program Mental health services On-staff wound specialist
Memory Care Senior Day-Care Hospice Care
General Practice Family Practice Internal Medicine
Endocrinology Pain Management Cardiology
Hygienist General health care Urology
Orthopedics GYN Ophthalmology
Plastic and Reconstructive Surgeries Counseling
Medicare Accepted Medicaid Accepted ACHC Accredited
Medi-Cal Accepted PPO's HMO's
Showers Locker Room Gated Community
Reception/Lobby area Liqour licence Full Kitchen
Walk in refrigeration Full bar Bar/Lounge
Outdoor Seating Counter-order Parties
Events Hood System Restaurant
Bar Laundry room Swimming Pool
Meeting Room Business center Spa
Gym
Nearby attractions Nearby activities
Property Image 1:
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Property Image 2:
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Property Image 3:
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Property Image 4:
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Property Image 5:
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Property Image 6:
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Property Image 7:
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Property Image 8:
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LOI Details:
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If you want to resubmit the LOI,
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