Confidential Buyer Form

Date:
Name:
E-Mail Address:
Home Address:
City:
State:
Zip:
Phone (home):
Phone (business):
Call in confidence: Yes  No
Fax:
BACKGROUND INFORMATION
Education
College(s)
Degree(s)
Business Experience: (Check all that apply)
Sales Marketing Accounting Retail
Engineering Finance Service
Marketing Distribution Operations
Other
Industries: .....
Positions: ..
Present Employer: .
Position: .
Salary: .
Address: ....
City:
State:
Zip:
Do you own any business presently? : .. Yes  No
If yes. what type(s) of business(es):
Approximate total annual revenue(s):
If no, is this your first acquisition for your own portfolio? : Yes  No
Are you interested in acquiring less than 100%ownership? : Yes  No
Will you be an: Active Manager    Passive Investor
How long have you been seeking acquisition?:
How soon is acquisition desired?: .
Purpose for acquiring?:
Are you the sole buyer / investor? : Yes  No
If no, how many others? :
Please provide information and resumes for all investors.
Investor 1
Name:
Address:
City:  
State:
Zip:
Phone:  
Active Manager   Passive Investor
Investor 2
Name:
Address:
City:  
State:
Zip:
Phone:  
Active Manager   Passive Investor
FINANCIAL INFORMATION
Combined net Worth of all investors:
Amount of investment equity available:
List and describe all cash sources
BALANCE SHEET
current as of
ASSETS/LIABILITIES:
Bank Line of Credit Availability
Cash Notes Payable 
Securities Accounts Payable
CD’s / Treasury Notes Mortgages
Real Estate Other Loans
Receivables Other Liabilities
Other Total Liabilities
Total Assets Net Worth
FINANCIAL REFERENCES
Financial Institution:  
Address:
City:
State:
Zip:
Contact Person:
Title:
Phone:
Lending Source:
Address:  
City:  
State:
Zip:
Contact Person: .
Title:
Phone: .
I certify that the above information is complete and accurate as of the date of this document and I authorize you to verify such information through reference and credit checks.
Digital Signature:
Title/Position:..
Date:
ACQUISITION CRITERIA
Description of Business(es) Sought:

GEOGRAPHIC PREFERENCE
Regions: ..
Cities:
Revenue Range: to
Transaction Value: to
Minimum Pre-Tax:
Minimum Cash Flow:  
Some of our businesses are actively operated by their current owners who would have to be replaced.
Are you interested in a full-time operator type business?   Yes  No
Are you willing to relocate?   Yes  No
SIC Codes of Interest.  Please indicate the SICs which accurately reflect your specific acquisition interest areas. Type the SIC code # in the boxes provided. SIC codes are listed below:
SIC Code #1 SIC Code #2 SIC Code #3
SIC Code #4 SIC Code #5 SIC Code #6
MANUFACTURING WHOLESALE TRADE
20 Food and Kindered Products 50 Wholesale Trade - Durable Goods
21 Tabacco Manufacturers 51 Wholesale Trade - Nondurable Goods
22 Textile Mill Products .
RETAIL TRADE
23 Apparel and Other Textile Products 52 Building Materials and Garden Supplies
24 Lumber and Wood Products 53 General Merchandise Stores
25 Furniture and Fixtures 54 Food Stores
26 Paper and Allied Products 55 Automotive Dealers and Service Stations
27 Printing and Publishing 56 Apparel and Accessory Stores
28 Chemical and Allied Products 57 Furniture and Home Furnishing Stores
29 Petroleum and Coal Products 58 Eating and Drinking Places
30 Rubber and Miscellaneous Plastic Products 59 Miscellaneous Retail
31 Leather and Leather Products .
SERVICES
32 Sand, Clay and Glass Products 70 Hotel and Other Lodging Places
33 Primary Metal Industries 72 Personal Services
34 Fabricated Metal Products 73 Business Services
35 Machinery, Except Electrical 75 Automotive Repair, Services, & Garages
36 Electrical and Electronic Equipment 76 Miscellaneous Repair Services
37 Transportation Equipment 78 Motion Pictures
38 Instruments and Related Products 79 Amusement and Recreation Services
39 Miscellaneous Manufacturing Industries 80 Health Services
.
TRANSPORTATION, COMMUNICATIONS,
ELECTRIC,  GAS & SANITARY SERVICES
81 Legal Services
41 Local and Interurban Passenger Transit 82 Educational Services
42 Trucking and Warehousing 87 Engineering, Accounting and Related Services
44 Water Transportation 88 Private Household
45 Transportation by Air 89 Miscellaneous Services
46 Pipe Lines Except Natural Gas
47 Transportation Services
48 Communication
49 Electrical, Gas and Sanitary Services
Please provide any additional comments related to your acquisition needs or strategy that would give added insight to selecting acquisition candidates for your consideration.

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