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)
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? Details:
Have you ever sold a business? Details:
Have you worked with an intermediary? 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
Stone, Glass & Concrete
32
Leather
31
Primary Metal Industries
33
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
Utility Services
49

 

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
Professional Services
86
Other
99
FUNCTIONAL EXPERIENCE
Please check appropriate boxes.
Production
Sales
Marketing
Finance
Accounting
Personnel
Distribution
Data Processing
Information Technology (IT)
Engineering
Other
 

LOCATION PREFERENCE
Please select appropriate state or province from the drop down list

Country:
 1st Choice 2nd Choice 3rd Choice
Canada
United States
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