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Borrower Intake Form

Any information provided through this form will be sent to Beechwood Capital Advisors, Scott Rothman: srothman@beechwoodcapitaladvisors.com

    Your Name:

    Phone Number:

    Your Email:

    Company Name:

    Industry:

    Background & History:

    Business Locations:

    Number of Employees:

    Distribution & Sales Channels:

    2019 Revenues:

    2018 Revenues:

    2017 Revenues:

    2020 Revenue Estimate:

    2019 FBIDTA:

    2018 FBIDTA:

    2017 FBIDTA:

    2020 FBIDTA Estimate:

    Accounts Payable:

    Short Term Debt:

    Long Term Debt:

    Mortgage Debt:

    Inventory:

    Receivables:

    Owned Real Estate:

    Top 3 Customers:

    Top 10 Customers:

    Reason for Financing:

    Amount of Financing Needed:

    Shareholder Net Worth:

    Non-Business Collateral Available (if any):

    Other Relevant Information:

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    We look forward to speaking with you.