• Take Action
  • Home
  • /Corporate Buyer Registration Form

Corporate Buyer Registration Form

This form is also available for Download as a PDF, which can be faxed to 260-485-4849.

General Information

Officer Name

Title

Corporate Name

Address

Address 2

Phone

Fax

Your Email (required)

Business Background and Industry

Objective for Acquisition

Specific Business Request

Industry:
RetailManafacturingDistributionServiceOther

Preference

Rank:

1)

2)

3)

4)

5)

NAICS Classification code(s):

Preferred Location of Business:

What is the Acquisition Timing?:

Amount of Pre-Tax Earnings EBITDA:
$

Amount of Funds to be Committed:

Optimum Revenue of Target Company:

Annual, Return on Investment
%

If there are Partners/Investors, Their Names and Involvement are:

Name:

1)

2)

3)

Involvement:

Do You Need any Other Approval(s) to Make the Decision to Purchase?:
YesNo

If Yes, What is Their Name and Relationship?:

Name:

Relationship:

If a Bank is Involved, has a Contact Been Made?
YesNo

Name of Bank

Loan Officer:

Location of Bank:

Phone #:

Signature of Corporate Representative

Authorized Officer