Corporate Acquisition Criteria Enrollment Form

A proper match of business and buyer is one of the keys to success in the purchase of a business. To assist Robbinex Inc. ("Robbinex") in determining a suitable business acquisition for your Company, we require some financial information and your criteria. Before releasing a seller's confidential financial information to you, Robbinex will need to evaluate your financial qualifications and check your references. This information is also added to our Buyer Data Base to ensure that all new acquisition opportunities are brought to your attention.

Fields marked with * are required

CORPORATE INFORMATION:

*Company Name:
*Contact Name:		Alternate Contact (partner/,assistant/Secretary)
*Address:		*City
Address (2) :		*Prov/State
*Office E-mail:		*Postal / Zip Code
Office Phone:		Office Fax:
Where did you hear of Robbinex?		Web Site Address:
How long have you been looking for an acquisition?		When is the ideal time for an acquisition?

INVESTMENT INFORMATION

Investment Level: (Range and/or Maximum)

$

to $

Max

Cash Available to Invest $	Institution Name (Location of Funds)	Name and Phone of person to verify funds:
Other Equity Available to Invest $	Institution Name (Location)	Name and Phone of person to verify funds:

ACQUISITION REQUIREMENTS

Revenue Requirements:	Min $		to $		Max
EBITDA Requirements:	Min $		to $		Max
Type of Business Preferred:
Type of Industry Preferred:
Is timing critical? If yes, why?
Goal of Acquisition (press ctrl+click to select multiple goals):	Expand Market Expand Customers Grow Revenues New Distribution Increase Plant Capacity Buyout Competitor New Production Technology Purchase New Technology Increase Production Capacity Other

ACQUISITION EXPERIENCE

How long have you been looking for an acquisition?

Preferred Geographic Location:

Has your company ever acquired another business or business unit?	select yes no	Dates and Details:
Have you ever divested a segment of your business?	select yes no	Details:
Have you worked with an intermediary?	yes no select	Details:
Do you have Established Corporate Criteria for Acquisitions:
What is unique about your acquisition process?

ACQUISITION TEAM

Members of the Acquisition Team:
Name	Position/Title	Responsibility	Contact Information (email address/phone number)
	Attorney Information
	Accountant Information

INDUSTRY STRENGTHS: Check where appropriate   Manufacturing Wholesale Hospitality Transportation Retail Service Other:

FUNCTIONAL AREA STRENGTHS: Check where appropriate   Sales Marketing Distribution Finance Accounting Information Technology Production Personnel Engineering Other:

NOTHING IN THIS BUYER REGISTRATION FORM IS INTENDED TO CREATE OR MAY BE CONSTRUED AS CREATING A PRINCIPAL AGENT RELATIONSHIP BETWEEN ROBBINEX AND YOU. YOU AGREE AND ACKNOWLEDGE THAT ROBBINEX'S SOLE UNDERTAKING IS TO TRY TO PROVIDE CERTAIN INFORMATION TO YOU. YOU WILL ENGAGE SUCH PROFESSIONAL ADVISORS AS YOU DEEM NECESSARY AND APPROPRIATE IN CONNECTION WITH A POTENTIAL ACQUISITION AND YOU CONFIRM THAT YOU HAVE NOT ENGAGED ROBBINEX TO PROVIDE ANY SUCH ADVICE TO YOU.

IMPORTANT:	To Receive a Detailed Business Profile, please be prepared to supply a Third Party Verification of Financial Capability (eg. Banker, Attorney, Accountant).
Company Signing Authority:
Date:
*Return E-mail: