Confidential Business Questionnaire

As a knowledgeable buyer, you understand that it is important we have adequate information for our records. Please complete this form, and if available, forward a resume and financial statement. Completing this form places you under no obligation. All information will be held in confidence.

Personal / Company Data
Company:
Name:
Address:
City:
State:
Zip Code:
Outside of the US?
Address/City/Province/ Post Code/Country

Telephone:	( ) - ext.
Fax:	( ) -
Tell us about your experiences:

Acquisition Data
Business location preferred

Type of business desired (Please specify types if known, and any helpful comments such as price range, SIC Codes, # of employees)

Manufacturing
Distribution
Service
Comments

Financial
Capital available for investment (Down Payment & Working Capital)

Approximate Net Worth
Bank Name
Bank Branch
Telephone	( ) - ext.