NJ: 973.376.0909 |

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:


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:



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.