Date MM slash DD slash YYYY Name* First Last Email* Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Home PhoneFaxCall in Confidence? Call Business Phone in ConfidenceBackground InformationEducation (College/Degrees)*Business Experience* Sales Manufacturing Accounting Retail Engineering Finance Service Marketing Distribution Operations Other What other business experience?*Industries*Positions*Present Employer* Position* Salary*Employer Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 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 less than 100% ownership?* Yes No Will you be an?* Active Manager Passive Investor How long have you been seeking an 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 for all investors (Name, Address, Phone)Please provide resumes for all investors Drop files here or Select files Max. file size: 50 MB. Financial InformationCombined Net Worth of all investors*Amount of investment equity available*List and describe all cash sources*Balance SheetCurrent as of:* MM slash DD slash YYYY Bank Line of Credit available*Assets:Cash*Securities*CDs/Treasury Notes*Real Estate*Receivables*Other Assets*Total Assets*Liabilities:Notes Payable*Accounts Payable*Mortgages*Other Loans*Other Liabilities*Total Liabilities*Net Worth*Financial InformationFinancial Institution* Financial Instituition Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Financial Insitution Contact Person* First Last Financial Insitution Contact Title* Financial Insitution Contact Phone*Lending Source* Lending Source Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Lending Source Contact Person* First Last Lending Source Contact Title* Lending Source Contact Phone*Information is complete* I certify that the above information is complete and accurate as of the date of this document*Signature* Reset signature Signature locked. Reset to sign again Title/Position* Date MM slash DD slash YYYY Acquistion CriteriaDescription of Business(es) Sought*Geographic Preference (Regions/States/Cities)*Revenue Range* Transaction Value Range* 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)* 0100-0900 Agriculture, Forestry, Fishing 1000-1499 Mining 1500-1799 Construction 201 Meat Packing, Sausages, Poultry Dressing & Egg Processing 202 Butter, Cheese. Milk, Ice Cream 203 Canned, Dried, Pickled, Frozen Fruit & Vegetables 2041-2046 Flour, Cereal. Rice Milling & Preparations 2047-2048 Petfood, Prepared Feeds, NEC 205 Bread, Cake, Cookies, Crackers 206 Sugar, Chocolate, Chewing Gum 207 Cottonseed/Soybeans/Vegetable/Animal Oil Mills 2082-2085 Malt, Wine, Brandy, Distilled Liquor 2086-2087 Soft Drinks, Flavoring Extracts 2091-2092 Canned, Cured, Fresh Or Frozen Seafood 2095 Coffee, Roasted 2097 Ice 2098 Macaroni & Spaghetti 2099 Food Preparations, NEC 2111-2141 Cigarettes, Cigars, Tobacco 2211-2241 Cotton, Synthetics, Wool, Fabric Weaving Mills 2251-2252 Women's Hosiery 2351-2352 Millinery, Hats & Caps 2361 Children's Dresses, Coats, Outerwear 2371 Fur Coats 238 Gloves, Robes, Belts, Waterproof, Accessories 239 Curtains, Housefurnishings, Textile Bags, Canvas 2411 Logging Camps & Contractors 242 Sawmills, Hardwood Flooring 243 Millwork, Hardwood/Softwood Veneer & Plywood 244 Wood Boxes, Pallets, Containers 245 Mobile Homes, Pre-fab Wood Buildings 249 Wood Preserving, Particle Board 251 Wood/Metal/Upholstered Household Furniture 252 Wood/Metal Office Furniture 253 Furniture for Public Buildings 254 Wood/Metal Partitions 259 Venetian Blinds, Shades, Furniture & Fixtures, NEC 261 Pulp Mills 262 Papermills Except Building Papermills 263 Paperboard Mills 264 Envelopes, Bags, Pulpgoods, Sanitary Products, Stationary 265 Boxes, Sanitary Food Containers, Fiber Cans 266 Building Paper & Building Board Mils 271 Newspapers 272 Periodicals 273 Book Publishing & Prinintg 274 Miscellaneous Publishing 275 Commercial Printing 276 Manifold Business Forms 277 Greeting Card Publishing 278 Looseleaf Binders & Bookbinding 279 Typesetting, Photoengraving, Electrotyping & Stereotyping 281 Alkalies, Industrial Gases, Inorganic Chemicals 282 Plastics, Synthetic Rubber, Man-Made & Organic Fibers 283 Biological, Medicinal, Botanical, Pharmaceutical Products 284 Soap, Polishing & Cleaning Goods 285 Paints & Allied Products 286 Gum & Wood/Industrial Organic Chemicals, NEC 287 Fertilizers 289 Adhesives, Explosives. Printing Ink, Carbon Black 291 Petroleum Refining 295 Paving Mixtures & Asphalt Felts 299 Lubricating Oils & Greases, Petroleum Products, NEC 301 Tires, Inner Tubes 302 Rubber, Plastic Footwear 303 Reclaimed Rubber 304 Rubber/Plastic Hose 206 Rubber Products, NEC 307 Plastic Products, NEC 311 Leather Tanning & Finishing 313 Footwear, Boot & Shoe Cutstock 314 House Slippers, Mens' & Ladies Shoes, Except Athletic 315 Leather Gloves & Mittens 316 Luggage 317 Women's Handbags, Leather Goods 319 Leather Goods, NEC 321 Glass, Flat 322 Glass Containers, Glassware, Pressed or Brown 323 Glass Products, Made Of Purchased Glass 324 Cement Hydraulic 325 Clay, Wall & Floor tile, Clay Products, NEC 326 Vitreous Plumbing, China Food Utensils, Porcelain Electrical & Potter Products 327 Concrete Products, Lime, Gypsum 328 Cut Stone & Stone Products 329 Abrasives & Asbestos Products, Mineral Products 331 Blast Furnaces, Steel Mills & Products 332 Foundries 333 Copper, Lead, Zinc, Aluminum 334 Secondary Metals 335 Copper/Aluminum/Wire Rolling Drawing & Extruding 336 Aluminum/Brass/Bronze/Copper Castings & Nonferrous Foundries, NEC 339 Metal Heat Treating & Products, NEC 341 Metal Cans & Drills 342 Cutlery, Hand & Edge Tools, Hardware, NEC EmailThis field is for validation purposes and should be left unchanged. 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