Private Company	Private Equity Group
Public Company	Individual Investor

I am interested in acquiring

Industry of Interest:
Manufacturing	Service	Wholesale
Retail	Distribution
Geographic Preference:
Northeast	Mid Atlantic	Southeast
Northwest	West	Southwest
Central	Mountain	Canada
Mexico	Other:

Preferred State:
Preferred Country:
Specific SIC Code:	Find SIC Code.

Here is my information:

First Name:
Last Name:
Title:
Company Name:
Industry:
Street Address:
Mailing Address:
City:
State:
Zip:
Country:
Primary Phone:
Alternate Phone:
Fax:
E-Mail:
Web Site:

Please contact me via:

E-Mail	Phone
Fax	US Mail

Here is some information about my current company:

Corporation or Partnership Name:
Year Established:
Number of Principals:
D&B Number:
Ticker Symbol:
Number of Acquisitions Completed This Year:
Number of Acquisition Completed Last Year:
Market Value Range:
Cash Available for Investment: