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Buyer registration

 

Please fill out the form below to register with us as a buyer. By doing so, you will be accepting the terms of our nondisclosure agreement. Please indicate by State and/or by listing identifier which store or stores you are interested in, as this information helps us better target your acquisition parameters.  If you prefer to provide this information by fax, print the form and send it to 801-751-5685, a secure, private fax number.  If you wish detailed information about specific listings currently posted on our website, please contact the identified associate.

*indicates required information

Name *
Name
Phone *
Phone
Cell Phone *
Cell Phone
Are you a Pharmacist?
States Registered to Practice?
What states are you registered to practice in. Check as many as apply.
Do you have any partners?
Do you currently own one or more pharmacies?
Very important - please tell us state, county, and town you are looking for.
Do not add commas
$
Source of Investment Capital *
Check all that apply
Name(s) of Advisors (Accountant, Attorney, etc.) List name and address for each advisor.
NDA *
You must read and acknowledge our NDA at the bottom of this form.