Confidential Questionnaire

The purpose of this biographical sketch is to assist both you and our firm in evaluating the possibility of working together.  Confidentiality is very important to us and your confidentiality will be maintained.

Please complete the following in its entirety:

Acquisition Interest:

Size range of company desired:   $   to  $ 

Desired Industries: 

Geographic Preference: 

Maximum Cash to invest: 

Maximum acceptable timeframe to closing (in months): 

How long have you considered acquiring a company (in months)? 


Contact Information:

First Name:    Last Name:

Home Address:


       City:      ,  State:    Zip Code: 

       Home Phone:       Work Phone:        FAX: 

       E-mail:        Cell Phone: 

       Net worth: $ 


Years of Functional Experience:

   CEO or Equivalent:       Marketing:         Sales:         Finance: 

   P& L responsibility including CEO or Equivalent: 

   Other (Please Describe): 

Are you currently employed:    Annual Compensation:  $

Current (or) previous compensation:  $   

Financial backers available: 

      If Yes, approximate amount available 

Would you consider a significant minority equity position if you have operating control? 

Do you have any other deals currently pending? 

          Key Strengths:


          Areas where additional support is required:


          What is your vision/mission/plan:


           How did you hear about us?


           Please paste your resume here:





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Last modified: 06/05/06