209 West 2nd Street, Suite 100
Little Rock, Arkansas 72201
Phone: 501.320.2450
Fax: 501.320.2451

Confidential Buyer Information Form

The information contained in this form will be held in strict confidence. PBBA is required by fiduciary responsibility to our sellers to qualify prospective buyers. We have obtained extremely confidential information on businesses offered (including tax returns, financial statements, etc.) and this information can only be shared with those who are financially qualified. Additionally, a completed Buyer Information Form will enable PBBA to focus on your business interests. We will respect your need to confidentially when calling your work or cell phone number.

* First Name:

* Last Name:


* Address:

* City:

* State:

* ZIP:


* Daytime Phone #:

Evening Phone #:

Fax #:

* Email Address:


Business Interests
Check areas of interest, you may specify in box










Do you check email regularly?:

Does anyone else view your emails?:

Do others view your faxes?:

$
Amount available for cash downpayment
toward a business?:

$
Amount available for operating capital
after a purchase?:



How did you hear about us?:

What is your time frame?:

Expertise, past experience, current occupation?:

Are there any constraints regarding business purchase?
(i.e.: must sell home, must sell business, family commitments)

Are there any other businesses you are interested in?

Company I am most interested in:



* Signature: Digitally sign with initials
* Dated: 
* I accept the Non-Disclosure Agreement


* Depicts a required field