Individual 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 you we require some personal 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. In addition to the information below, please feel free to submit your own financial statement, any additional material you feel would be helpful and, if you have one, a resume. This information is also added to our Buyer Data Base to ensure that all new acquisition opportunities are brought to your attention.

PLEASE NOTE THAT ALL INFORMATION PROVIDED IS HELD IN STRICT CONFIDENCE.
Fields marked with * are required

PERSONAL INFORMATION:

*Name
*Address
*Home Phone		*City
*Office Phone		*Prov/State
*Fax		*Postal / Zip Code
Where did you hear of Robbinex?		General Business Interests:
How long have you been looking for an acquisition?

PROFESSIONAL INFORMATION:

Present Employment
Address
Position
Job Description
Professional Experience / Skills / Education: (Please attach a copy of your Curriculum Vitae (resume) , if available)
Prior Job History ( Company Product/Service)
Job Description for above
Companies Owned
Company Product?Service (for above )

FINANCIAL INFORMATION:

INVESTMENT LEVEL ( Cash Available to Invest)	- Select Investment Level - Less Than 500K Up To 500K Up to 1M Up to 5M Up to 10M Up to 25M 10M Plus 25M Plus
Other Capital Available ( Explain )

ACQUISITION EXPERIENCE

How long have you been looking for an acquisition?

Preferred Geographic Location:

Have you ever purchased a business before?	select yes no	Details:
Have you ever sold a business?	select yes no	Details:
Have you worked with an intermediary?	yes no select	Details:
Companies Owned:		Company Product Service:
General Business Interests:

NDUSTRY INTEREST (Please check appropriate boxes)

MANUFACTURING SIC Experience Interest Food 20 Textile 22 Apparel 23 Lumber & Wood 24 Furniture 25 Paper 26 Printing & Publishing 27 Chemicals 28 Rubber & Plastic 30 Leather 31 Fabricated Metal 34 Machinery 35 Electronic 36 Transportation Equip. 37 Instruments 38     WHOLESALE SIC Experience Interest Whl trade, Durable 50 Whl trade, Non-Durable 51     HOSPITALITY SIC Experience Interest Restaurant 58 Hotel, Motel. Inn 70 Other hosp

TRANSPORTATION / COMMUNICATION SIC Experience Interest Taxi, Bus 41 Moving, Storage 42 Transportation Services 47 Communication 48   RETAIL SIC Experience Interest Building, Garden, & Hardware 52 General Merchandise 53 Food Stores 54 Automotive Dealers 55 Apparel 56 Furniture 57 SERVICE SIC Experience Interest Trade Contractors 15 Building Construction 15b Finance, Insurance, Real Estate 66 Personnel 72 Business Services 73 Automobile Repair 79 Amusement 79b Health 80

FUNCTIONAL EXPERIENCE Please check appropriate boxes. Production Sales Marketing Finance Accounting Personnel Distribution Data Processing Engineering Other

LOCATION PREFERENCE Please select appropriate state or province from the drop down list Country: 1st Choice 2nd Choice 3rd Choice Canada Select Province Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Select Province Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Select Province Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon United States Select a State Outside US Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Is Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Select a State Outside US Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Is Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Select a State Outside US Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Is Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Other Additional Comments:

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).
Name of Individual:
Address:
Date:
Telephone:
*Return E-mail:

(Canada) 80 Bancroft Street, Hamilton ON L8E 2W5 Tel.: (905) 523-7510 Fax (905) 523-4998
(United States) 120 Church Street, Buffalo,NY 14202 Tel: (716) 819-0304 Fax: (716) 819-0305

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