Company Name:

Main Contact Name:  

Title:   Email:  

Would you prefer to be contacted by:

Telephone
Email

Company Address:

City:   State:   Zip:

Telephone:   Fax:

Home Address:

City:   State:   Zip:

Telephone:   Fax:

Business Organization:

Sole Proprietorship
S Corporation
C Corporation

General type of business (estimate % if business activities are in more than one area):

Manufacturing - percent of activities %

Distrbution - percent of activities %

Service - percent of activities %

Retail - percent of activities %

Describe the products and services you sell:

Describe the type of customers you serve:

Do you sell:

Locally
Regionally
Nationally
Internationally

Age of Company?     Approx. Gross Sales? 

Number of Employees? 

Reason for considering sale:

Timing of Sale:

Other Comments: