Buyer Interest and Prequalification Profile


Paragon Ventures represents sellers of established, profitable businesses in the medical / healthcare service industry.  Our client agreements require us to obtain certain qualifying information from buyer prospects before the name and location of any client can be disclosed.  When completing this form, please attach any additional information that you feel is appropriate including resumes, acquisition search criteria, financial statements and / or financial references.

This information is essential to accurately match a buyer’s acquisition criteria with the wide range of selling situations marketed by Paragon Ventures.  Please complete each part of this form and return it to Paragon Ventures LLC to obtain information on a specific business acquisition opportunity.  No financial information will be released to a potential buyer without receipt of a fully executed Confidentiality Agreement and evidence of financial capacity.

 

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please select a user name and password 

User Name
Password
Confirm Password

Select any of the following options that apply:

Individual Investor(s)
Corporation (Public)
Corporation (Private)
Private Equity Group
Other

Select how you heard of Paragon Ventures:

Internet
Trade Show
Friend
Newspaper
BizBuySell
BizQuest
Industry Association
Prior Client
Other

Current Employment?


Career Background?


Education?

 

Corporate Financial Prequalification

Please describe your current business model: business products and/or services.

Stock Exchange

Ticker Symbol

Year Established

Number of completed acquisitions in past five years

Dun's Number or Financial Reference

Please describe your current healthcare related portfolio companies.

Cash budgeted for acquisitions

Preferred transaction structure (% cash, notes, stock, etc)

Individual Financial Prequalification

Have you ever owned or been a 10% or more owner of a healthcare business: Yes No

Please describe your current healthcare related investments/portfolio companies.

Cash Available for Investment?


Sources of additional funding?


Assets

Current Assets: Cash


Current Assets Receivables


Current Assets: Real Estate

Current Assets: Securities/CDs

Current Assets: Fixed Assets

Current Assets: Other

 

Liabilities

Current Liabilities: Notes Payable

Current Liabilities: Mortgages

Current Liabilities: Other Loans

Current Liabilities: Other Liabilities

Please click which of the following sectors best describes your area of interest.  (To make multiple selections, continue to hold down the CTRL or APPLE key while clicking all desired items)

Please describe the ideal business to be acquired

Financial parameters of acquisition target

Annual Sales:            Minimum      Maximum 

Pre-tax earnings        Minimum      Maximum 

 

Management Preference

Will replace top management

Competent top management should remain

 

Geographic Preferences

 

Other Notes and Comments which can help us identify the best possible acquisition opportunities

 


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Revised: 02/24/07