Seller Profile

If you would like a confidential preliminary evaluation of your store, without any obligation and without revealing the store name and location, fill out this form without the contact information requested and hit submit. We will return it to you via e-mail. If you prefer to fax the form, please download the printable form.

Store Name

Owner's Name

Store Address

Phone Number

Home Phone Number

Cell Phone Number

E-mail (required)

NCPA Membership Number (if applicable)

Type of Location (urban, suburban, rural, shopping center, stand alone building, clinic)

State of Location

Very important. Please make a selection!

Competitors (how many and what kind, chains, independents, distance from store)

Store Hours

Store Size, Selling Area, Storage Areas

Staff (pharmacists, technicians, other, any specialty personnel (surgical fitters, etc.))

Premises (owned or leased, if leased, remaining term in years, base monthly rental, additional rent, taxes, etc., renewal options if any)

Sales Volume for the past three years, gross and net margins if available

Prescription Volume (daily Rx count - weekdays and weekends, Rx breakdown, third party vs. cash)

Sales Mix (Rx vs. OTC, any special categories, surgicals, cards and gifts, etc.

Value of Inventory

Date of most recent physical inventory taken

Reason for proposed sale

Desired Timing

Best Method and Location for Contacting You