Buyer Profile and Personal Financial Statement.

The purpose of the following form is to collect information about the Business Applicant and its owners’ financial condition. Corner Realty’s client will use this information as one of a number of data sources in analyzing the repayment ability and creditworthiness of the applicant in his/her proposal to purchase convenience stores, retail facilities, real estate, business equipment, and/or business goodwill. Failure to provide the information could negatively impact your selection as a Qualified Bidder for the business and property associated with this project.

Complete all that apply.

Any additional information / explanations can be included in the information section.

Review the applicable certifications and e-sign (spousal signature, if required)

Buyer Profile and PFS

Step 1 of 9

Buyer Profile and Bid Detail

Entity Address
Please provide written background on your current business and business assets, including number of retail locations currently owned, currently operated, geographical locations, and other relevant information to be considered with your proposal.

Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a denial of your loan or surety bond application. A false statement is punishable under 18 U.S.C. §§ 1001 and 3571 by imprisonment of not more than five years and/or a fine of up to $250,000; under 15 U.S.C. § 645 by imprisonment of not more than two years and/or a fine of not more than $5,000; and, if submitted to a Federally-insured institution, a false statement is punishable under 18 U.S.C. § 1014 by imprisonment of not more than thirty years and/or a fine of not more than $1,000,000. Additionally, false statements can lead to treble damages and civil penalties under the False Claims Act, 31 U.S.C. § 3729, and other administrative remedies including suspension and debarment.