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INFORMATION INTAKE FORM

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  • Business or Property TypeBus./
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    Type
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Owner 1: Email:
Owner 2: Email: More Owners
Owner 3: Email:
Owner 4: Email:
Owner 5: Email: Less Owners
Business Legal Name: DBA:
Asking Price: FF&E:
Inventory Included in Price: Yes No Estimated Inventory:
Franchise Y/N: Yes No Franchise Transfer Fee:
Individual(s) A Partnership A Corporation An LLC An LLP Other
Ownership Type: Own Rent Lease Sub Lease Under Contract to Own
Business Address: Make Address Confidential
City: State: Zip:
County: Website:
Select state first...
Business Tel: Fax:
Description:
Type of Business (Check all that apply):
Restaurant Seats:  Medical Office Salon/Beauty/Spa Fitness/Gym Retail
Hotel/Motel Rooms:  Liquor Store Manufacturing/Industrial Clothing
Club Sports Club Multi Family #Units:  Office Condo Office Building
Property Type: Property Sub Type:
No of Licenced Beds: Speech Therapy:  Occupational Therapy:  Physical Therapy: 
Trading Hours: Other Services: Support & Training:
Competition / Market: Expansion Potential:
Year Established: Home Based: Relocatable:
Reason for Sale:
Dining Seats: Bar Seats: Patio Seats:
Trading Hours: Support & Training:
Competition / Market: Expansion Potential:
Year Established: Home Based: Relocatable:
Reason for Sale:
Number Of Vehicles: Number Of Bays:
Trading Hours: Support & Training:
Competition / Market: Expansion Potential:
Year Established: Home Based: Relocatable:
Reason for Sale:
Beds:
Support & Training:
Competition / Market: Expansion Potential:
Year Established:
Home Based: Relocatable:
Reason for Sale:
Buildings: Stories: Units:
Year Built: Year Renovated: Tenancy:
Number of Tenants: Occupancy: Parking Spaces:
Permitted Zoning:
Trading Hours: Support & Training:
Competition / Market: Expansion Potential:
Year Established: Home Based: Relocatable:
Reason for Sale:
Buildings: Stories: Units:
Year Built: Year Renovated: Tenancy:
Occupancy: Parking Spaces:
Permitted Zoning: Reason for Sale:
Buildings: Ceiling Height: Stories:
Units: Year Built: Year Renovated:
Tenancy: Number of Tenants: Occupancy:
Parking Spaces: Permitted Zoning: Reason for Sale:
Beds: Buildings: Rooms:
Stories: Year Built: Year Renovated:
Occupancy:
Living Accomodation:
Amenities & Sevices:
Parking Spaces:
Permitted Zoning:
Competition / Market: Expansion Potential:
Year Established: Home Based: Relocatable:
Support & Training: Reason for Sale:
Beds: Buildings: Units:
Stories: Year Built: Year Renovated:
Parking Spaces: Permitted Zoning: Tenancy:
Trading Hours: Support & Training:
Competition / Market: Expansion Potential:
Year Established: Home Based: Relocatable:
Reason for Sale:
Sales Price: Price/sq ft: Property Tax:
Utilities Estimate: Home Owners Insurance:
HOA: Down Payment:
Appraised Value:
Additional fields…
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
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:
Medicare Accepted: Medicaid Accepted: ACHC Accredited:
Medi-Cal Accepted: PPO's: HMO's:
Insurances Accepted:
Real Estate included: Experience needed:
Apartments: Cabins: Condos:
Rv parking Spaces: Campsites:
Restaurant
Bar
Laundry room
Swimming Pool
Meeting Room
Sauna
Jacuzzi
Steam Room
Conference Room
Business center
Spa
Gym
Absentee owner operation 
owner-operated
semi-absentee owner
Security System
Parties
Events
Hood System
Nearby attractions: Nearby activities:
Liqour licence
Full Kitchen
Walk in refrigeration
Full bar
Bar/Lounge
Outdoor Seating
Counter-order
Absentee owner operation 
Owner-Operated
Semi-Absentee owner
Security System
Parties
Events
Hood System
Permitted Zoning:
Multiple locations
Absentee owner operation
Owner-operated
Semi-absentee owner
Security System
Absentee owner operation
Owner-operated
Semi-absentee owner
Walk in Cooler
Security System
Absentee owner operation
Owner-operated
Semi-absentee owner
Security System
Absentee owner operation
Owner-operated
Semi-absentee owner
Multiple locations
Locker Rooms
Showers
Sauna
Security System
Private workout suites:
Office
Kitchen
Dining Room
Activity Room
Garden
Laundry Room
Meals provided
Hair stations: Nail Stations: Pedicure Stations:
Tanning Stations: Spray Tanning Units: Massage stations:
Absentee owner operation
Owner-operated
Semi-absentee owner
Security System
Break room
Sauna
Steam Room
Jacuzzi
Hair
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
Experience Necessary
Offices: Conference room: Break Room:
Restrooms: Elevator: Virtual Offices:
Reception/Lobby area
Gated community
Bedrooms: Bathrooms:
House Type:
Stories:
Other Rooms:
Year Built: Building Size sq ft: Lot Size Acres:
Heating: Cooling:
Interior Features: Exterior Features:
Parking Type: Parking Spaces:
Appliances Included: Amenities:
Permitted Zoning: Last Sold:
Nearby Schools:
Please list any other specifics about your business that we should know:
Annual Gross Revenue:
Annual Net Profit:
EBITDA:
Lotto:
Food Sale:
Cigarette Sales:
Catering:
Parties:
Dine-In:
Delivery:
Annual Rental Income:
Bar Sales:
Grocery Sales:
Liquor Sales:
Check Cashing:
Annual Taxable Sales:
Annual Non-Taxable Sales:
Annual Other Income:
Premium(gal/yr):
Premium Markup(¢/gal):
Regular(gal/yr):
Regular Markup(¢/gal):
Unleaded(gal/yr):
Unleaded Markup(¢/gal):
Diesel(gal/yr):
Diesel Markup(¢/gal):
Other(gal/yr):
Other Markup(¢/gal):
Car Wash:
Car Wash Ann Rvn($):
Has Market:
Market Ann Rvn($):
Has Restaurant:
Restaurant Ann Rvn($):
**Ann Rvn: Annual Revenue
Monthly Rent: NNN:
Electric: COG: Payroll:
Royalties:
Utilities: Insurance: Advertising:
Other Expenses:
Number of Employees:
Full Time: Part Time:
Non Manager: Yes No
Lease Information: Lease Years Left: Option Terms:
Building/Lot Size: Heated SQ: Lot SQ:
Please list any other specifics about your business that we should know:
Property Image 1:
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Property Image 9:
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Property Image 10:
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