Firm Name:

Firm Contact:

Address:

Telephone Number: 

Fax Number:

E-mail address:

 Plan to sell/merge your firm?   Check:  No     Yes

(if yes, check below)

 As soon as possible

 Within the next year 

 Within the next 1 to 5 years

 Plan to acquire/merge another firm?  Check:  No     Yes

(if yes, check below)

As soon as possible 

 Within the next year  

 Within the next 1 to 5 years

 Size of firm you are to buy/sell/merge:

Gross receipts between $200,000 and $500,000 

Gross receipts between $500,000 and $1,000,000

Gross receipts greater than $1,000,000

 Firm is a:

Sole proprietorship

 Other

 List your geographic area of interest:

 State:

Specific City:

County or Region: