BUSINESS INTERMEDIARY SERVICES, LTD.
1 WEST PACK SQUARE, SUITE 507, ASHEVILLE, NC 28801.
PHONE (828) 285-0018 ·  FAX (828) 285-0071

CONFIDENTIAL CORPORATE BUYER QUESTIONNAIRE

This questionnaire is to be used by public and private corporate acquires and investment groups. Print out form and return by fax or mail to BUSINESS INTERMEDIARY SERVICES, LTD. High net worth individuals use the CONFIDENTIAL INDIVIDUAL BUYER QUESTIONNAIRE

Date____________________

Company: _____________________________

Contact Person: ____________________________

Title__________________________________

Address:_________________________________________

City:________________________________ State:___   Zip Code: _______________

Business Phone: (_____) _______________

Fax: (_____) _______________

E-mail: _____________________________ Web site _____________________________________

Description of Business(es): _________________________________________________________________

SIC Codes of Present Business (es): _______  _______  _______  _______  _______  _______  _______

19___  Sales Revenue: $_________   Pretax: $_________   Net Worth: $_________  Employees: _______

Financial Reference: ________________________

Phone:(_____) _______________

Contact Name: _____________________________

Title: ________________________

Public Company (    )

Private Company (    )

Venture Capital (    )

Private Investment Group (    )

Merchant Bank (    )

Holding Company (    )

Other: (    ) ______________________________________________

To be completed by PRIVATE INVESTMENT GROUPS only:

Equity Funds Available for Acquisition: Committed $________ Uncommitted $________
Equity Investment Per Transaction: Minimum $________  Maximum $________
Mezzanine Funds Available: $________
Describe Source of Funds:________________________________________________
No. of Acquisitions Completed: _______ Market Value $_______ to $_______

ACQUISITION CRITERIA

SIC Codes which currently reflect your specific acquisition interest areas:

Same as Line of Business SIC Codes above (    )

Other:

______

______

______

______

______

______

______

______

______

Geographic Preference:     Entire USA: (    )         Specific States indicated on SEPARATE PAGE: (    )

General Areas of Interest: (Indicate 1-4, 1 = First Choice)

Manufacturing: (     ) Distribution (     ) Service (     ) Retail (     )

Acquisition Motivation: Strategic Fit (    )  Diversification (    ) Financial/Opportunistic (    )

Revenue Range: $_______ to _______ million Market Value: $_______ to _______ million

Minimum Pretax: $_______ Minimum Cash Flow: $_______

Please provide additional comments related to your acquisition needs on separate page.