Name

First Name

Last Name

Telephone Number

Checkbox

Please specify the following

An agent acting on the behalf of a third party

Owner of a business looking for a sale

Legal Entity Name (target company)

Target company for acquisition

Business Sector

Please identify which business sector of the target company

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Last 12 Months Turnover

Gross turnover

Current Valuation

Gross valuation assumption as of the current date

Premium Sought

Gross premium on any stock, assets or shares sought

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M&A Submission Form

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