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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