Have you previously spoken to, or worked with, any other broker regarding any listing of Eighty Six Business Brokers? *

Yes

If yes, whom:

Listing 1 — Business

Listing 1 — Address

Listing 1 — Price $

Listing 1 — Date Disclosed

Listing 2 — Business

Listing 2 — Address

Listing 2 — Price $

Listing 2 — Date Disclosed

Listing 3 — Business

Listing 3 — Address

Listing 3 — Price $

Listing 3 — Date Disclosed

Cash on hand (readily available) $

Value of securities $

Equity in real estate $

Funds available from family/investors $

Anticipated financing (lender, if any)

Prior restaurant/business ownership experience

Buyer Signature *

Clear

Buyer Initials

Address

Street Address

State

City

Postal Code

Phone *

Email *

Last Name *

First Name *

Additional Buyer — Print Name

Additional Buyer — Initials

Checkbox 1gpj *

I agree to the terms of this Confidentiality, Registration & Nondisclosure Agreement (Form 86-BRK-002). I understand a copy delivered electronically is as effective as an original.