State of Incorporation:
Members/Shareholders Information:
Authorized Representative Name:
Email Address:
Phone Number:
Description of Goals:
Seller Entity Name:
Seller Entity State of Incorporation or Organization:
Seller Entity tax status:
Seller Authorized Representative Name:
Seller Authorized Representative Title:
Seller Authorized Representative Email Address:
Purchases Entity Name
Purchaser Entity State of Incorporation or Organization:
Purchaser Entity tax status:
Purchaser Authorized Representative Name:
Purchaser Authorized Representative Title:
Purchaser Authorized Representative Email Address:
Purchaser Authorized Representative Phone Number:
Have the parties entered an NDA?
Is this an equity or asset purchase?
Equity
Asset
If purchasing equity, please list the percentage of equity:
If purchasing assets, are you purchasing substantially all assets?
If not, please provide short description of the assets, including contract title if applicable, or name of business division:
Which state( jurisdiction) will govern this agreement?
What is the purchase price?
How much cash will be received at closing?
Will there be an earnout?
If yes, please provide description of amount and any requisite milestones.
Will there be Seller Financing?
If yes, please list amount or percentage of Purchase Price.
Will there be a Purchase Price Adjustment?
Will there be a Purchase Price Adjustment Escrow?
If yes, please list amount or percentage of Purchase Price.
Will there be an Indemnification Escrow?
If yes, please list amount or percentage of Purchase Price.
Will there be rollover equity?
If yes, please list percentage of Purchase Price.
Will there be exclusivity between the parties?
If yes, please provide the proposed term.
Will offers be given to key employees?
If yes, please list names of key employees and relevant details regarding bonuses.
Will Transition Services Be Provided?
If yes, please provide description of services, term, and rate.
