Preferred Industry/Business Type:

Preferred Location:

Time frame to purchase business:

Minimum Net Income Required: $

Maximum Price Range Desired: $

What is your motivation for buying a business?

Source of down payment:

Will you be:

Present Occupation:

Have you operated a similar business?

Yes No

If yes, how long?

How long have you been looking?

Have you made any offers?

Yes No

If yes, please explain:

Are you interested in learning more about using retirement fund penalty & tax free?

Yes No

Additional Comments: