Confidential

Client Interest Registration


IMPORTANT NOTICE TO PROSPECTIVE CLIENTS

Paragon Ventures represents established, profitable businesses in the medical | healthcare | life sciences industry.  This information provided herein is confidential and will not be shared or disclosed to any other party without the expressed written consent of the client and is used solely to initially assess your business.  Please complete each part of this form and return it to Paragon Ventures LLC.  No financial information will be released to a potential buyer without receipt of a fully executed Confidentiality Agreement and evidence of financial capacity.

Your Interests::

We are interested in SELLING our business.
We are interested in learning more about strategic EXIT PLANNING
We are interested in current MARKET VALUATION for our business .
We are interested in recent mergers and acquisition transactions.
We are interested receiving the Paragon Ventures M&A InSight Newsletters.

Which of the following best describes your interest?

    

 

Contact information:

* First Name
* Last Name
* Title
* Organization
Street Address
Address (cont.)
City
* State/Province
Zip/Postal Code
Country
* Phone including area code
FAX
* E-mail
Website URL
Preferred method of contact:
Business Phone      Mobile Phone      E-mail

Please indicate your current products | Services provided:
ALF/SNF Pharmaceutical Distributors
Dental Practices   Pharmacy Benefits Managers (PBM)
Diabetic Supplies   Physical/Occupational/Speech Therapy
Disease Management   Physician Practice Groups
Group Purchasing Organization (GPO)   Retail Pharmacy
HME   Respiratory Therapy
Home Nursing   Specialty Pharmacy
Hospice   Staffing/Staffing Facilities
Infusion Therapy   Surgery Centers
Institutional Pharmacy   Sleep Labs
Mail Order Pharmacy   Women's Health
Medical/Dental Product Manufacturers   Specialty Beds/Wound Care
Outpatient Rehabilitation Facilities   Medical Equipment Rental (B2B)
Hospitals- Acute Care Facilities      
Healthcare Billing/Reimbursement      
Medical Device - MFG   Other: Please specify in Comments sections below  
         
         

Geographic Location:
East Coast      West Coast      South      Mid-West      Anywhere

Please briefly describe your business and market focus:
Business Profile
C Corporation  S Corporation   LLC  Partnership       Public Company      Other 
Number of Stakeholders
Stock Exchange
Ticker Symbol
Year Established
Gross Sales
Net Earnings
Describe your main product /service
DUNS #/Financial Reference

Product Mix

As a percentage of collected revenue:

Product / Service: 1            % of collected revenue
Product / Service: 2            % of collected revenue
Product / Service: 3            % of collected revenue
Product / Service: 4            % of collected revenue
Product / Service: 5            % of collected revenue
                                Product/Service Group Other      % of collected revenue   
                 Number of employees     Number of branch locations
   

Does the owner have an active role in management?

    

How did you find Paragon Ventures?
(hold down the ctrl key for multiple select):

    

Comments

       

 

  Prospective Client Profile Confidentiality Agreement

 

 

           I have read and agree with the terms of the Seller Confidentiality Agreement.

     

           I would like to receive further communications from Paragon Ventures and/or Highway Capital LLC

 

By typing your FULL NAME in the field below, you are signing this document as it relates to the information in the above Seller Registration Profile  and Confidentiality Agreement:

* (required) Signature (FULL NAME):  

 

Validation:  For security purposes, please add two plus two and enter the answer in digital form in the box below.

 (this will confirm you are human).

 

 

 


 

Click here to schedule a private conference with the principles of Paragon Ventures or call us at 1-800-719-1555.