Amerivest Group

Buyer Confidential Registration Form
The following information will help us best serve your needs and assign an associate.
First Name:	Last Name:	Phone:		Cell:

Fax:	E-mail:	City:		State:

Listing Numbers:

Price Range: From To		Down Payment: From To

If financing is available what is the maximum debt that you would be comfortable with? $

Preferred Language:		Owners Benefit: From To

Preferred Business Type
1: 2: 3:
Geographic Preference:
Option 1: Option 2: Option 3:

Work Experience:

Strongest Aptitudes: Accounting Marketing Sales Management Administration

Will you operate this business yourself yes with partner or spouse?

When we identify a business for you how soon could take possession?			Weeks	Months

Additional Information that may help us to assist you.