To
obtain a password - PLEASE Click
Here To Print This Page,
complete, SIGN
S. G. READER & ASSOCIATES, INC. PO BOX 161~ SEDONA , AZ 86339 OR FAX #: (480) 575-7248
*MAKE
SURE TO LIST E-
CONFIDENTIALITY & AGENCY DISCLOSURE
AS A PROSPECTIVE BUYER I HEREBY CERTIFY
THAT I AM NOT
IF I AM A BROKER AND/OR THE AGENT, I AGREE THAT I HAVE BEEN RETAINED BY THE BUYER OF A CLINIC. I AM OBTAINING A PASSWORD AND/OR ADDITIONAL INFORMATION FOR THE SPECIFIC PURPOSE OF DUE-DILIGENCE ONLY.
I FURTHER AGREE NOT TO CONTACT THE DOCTOR/OWNER AND/OR STAFF OF SAID BUSINESS WITHOUT THE CONSENT OF S.G.READER & ASSOCIATES, INC.
BUYER
IS AWARE THAT THIS IS NOT A
SHOULD
I DECIDE NOT TO PURCHASE THIS BUSINESS I WILL RETURN
I
HAVE BEEN TOLD THAT S.G. READER
BUYER
IS AWARE THAT THE SELLER
BUYER
WILL HOLD S.G.READER & ASSOCIATES, INC.
HARMLESS PERTAINING TO ANY
BUYER
ACKNOWLEDGES
PLEASE CHECK YOUR PROFESSION _______D.C. _______P.T. _______M.D. ______D.D.S. OTHER (SPECIFY)_____________________________________
____________________________________________________________________________________
__________________
PROSPECTIVE BUYER (PRINT
NAME)
DATE
________________________________________________________________________________________________________________
ADDRESS
_______________________________
____________________________________________
HOME PHONE
_______________________________
____________________________________________ (We will email you your
password)
BUSINESS PHONE
*E-
__________________________________________________________
____________________________________________
SIGNATURE
FAX NUMBER