Buyer’s Registration Form

General Information

Contact Name*

Contact Position / Job Title*

Company Name*

Address*

Address 2

City*

State / Province*

Postal / Zip Code*

Country*

Cell Number*

Office Number*

Email Address*

Company Information

Number of Shareholders*

Names of Shareholders*

Buy Side Category* PrivatePEGStrategicRoll Up

Type of Acquisition Target by Industry*

Size of Acquisition*

EBITA or SDE Amount of Cash Flow*

Funding the Transaction – Please provide details*

Post-Acquisition Intentions* Active Management Role – Day to DayPassive Remote Involvement

Comments

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