Business Broker Form

Business Broker Form
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Name under which Business Broker business primarily is conducted if different:
Firm’s Main Address (if P.O. Box, must have legal address): Include Addresses of all Branch Offices in Illinois on additional sheet
Type of Legal Status
- Corporation
- Partnership
- Sole Proprietorship
- Limited Liability Company
- Limited Liability Partnership
If Sole Proprietor, full Residence and Social Security Number.
If at the time of this filing, the applicant is succeeding to the business of a currently registered Business Broker:
In the past 10 years has the Applicant been convicted of or pleaded guilty or nolo contendre (no contest) in a domestic or foreign court to:
A felony or misdemeanor involving: investment, financial, business broker or related business fraud, false statement, or omissions, wrongful taking of property, or bribery, forgery, counterfeiting or extortion:
- Yes
- No
Any felony (other than listed above):
- Yes
- No
Has any domestic or foreign court in the past 10 years enjoined the applicant in connection with investment, financial or business related activity:
- Yes
- No
Ever found the applicant to have made a false statement or omission, or been dishonest, unfair or unethical?
- Yes
- No
Ever found the applicant to have been involved in a violation of investment, business or financial regulations or statutes?
- Yes
- No
Ever found the applicant to have been a cause of a business broker, investment or financial related business having its authorization to do business denied, suspended, revoked, restricted or otherwise adversely affected?
- Yes
- No
In the past 10 years entered an order against the applicant in connection with an investment, financial or business broker related activity?
- Yes
- No
Ever denied, suspended, revoked or otherwise adversely affected the applicant’s registration or license, prevented it from associating with an investment, financial or business broker related business, or otherwise disciplined it by restricting its activities?
- Yes
- No
Ever revoked, suspended or otherwise adversely affected the applicant’s license as an attorney or accountant?
- Yes
- No
Has any foreign government, court or regulatory authority ever entered an order against the applicant related to financial activity or fraud other than as reported above?
- Yes
- No
Is the applicant now the subject of any proceeding that could result in a “yes” answer to any parts of Section 11?
- Yes
- No
Has a bonding company denied, paid out on or revoked a bond for the applicant?
- Yes
- No
Does the applicant have any material unsatisfied judgements or liens against it?
- Yes
- No
Terms
- I accept all the terms and condition.
- The information I given above is best of my knowledge.

Business Broker Form

Your Company Name

A brief intro is always great. It's Helps people to identify your company.