Buyer’s Application

PERSONAL INFORMATION
  5. (required)
  6. (required)
  7. (required)
  8. (required)
  9. (required)
  13. (valid email required)
EDUCATION/PROFESSIONAL INFORMATION
  5. If applicable, please describe your current employment situation, including compensation. Attach a resume, if available.
  10. Which would you prefer?
FINANCIAL INFORMATION
  3. Do you have any credit problems that might affect your ability to borrow money for the acquisition of a practice (low credit score, late or missed payments, etc)?
NON-DISCLOSURE ACKNOWLEDGEMENT
  1. CLIENT ACKNOWLEDGMENTS: Client hereby acknowledges and agrees: that all information provided to CTC by Client is true and correct to the best of client’s knowledge and may be presented to prospective sellers, and no material facts shall be misrepresented or omitted; to authorize CTC to investigate Client’s personal and credit history; that it is Client’s sole responsibility to investigate all information provided by prospective sellers and CTC including conducting an audit of the practice’s patient charts; that Client has been advised to have an attorney review all documents provided by CTC and that any advice and/or opinion on the legality, validity, effect, tax and/or other consequences pertaining to a transaction, or any additional provisions or modifications required for the documents must be provided by Client’s attorney; and that consultant may provide consultation services to other parties to the practice transition, such as the seller, for a fee paid by other parties. NON-DISCLOSURE: Client agrees that all information provided by CTC is confidential, and agrees not to disclose to anyone or make copies of any of the information, ideas, procedures, programs, contracts, or other data entrusted to the undersigned, without the prior written consent of CTC. Client warrants and agrees not to disclose the name of circumstances of any parties introduced to Client by CTC, and that, upon request, all information provided for any uncompleted transaction will be immediately returned to CTC.
 

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