"*" indicates required fields Name* First Name Last Name Email* Organization Country Code (United States = +1)* Phone (Mobile Preferred)*Are you a United States Citizen?*Select from availableYes, living in the United StatesYes, not currently living in the United StatesE2-VISA HolderE2-VISA ApplicantOther legal permanent VISA holderNo, living outside of the United StatesNo, UndocumentedSelect Your Location:*United StatesInternationalAddress (United States)* Street Address City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country HiddenWhat amount of liquid funds do you have available to put towards a business acquisition?Do you have non-borrowed liquid funds available for a business acquisition equal or greater than 10% of the total purchase price?* Yes No Principal Buyer*Select from availableI am inquiring on behalf of myself and would be the principal buyer/owner/operator.I am inquiring on behalf of myself and a potential non-family business partner.I am not intending to be active in the business and will be a financial owner/partner.Potential Competitor*Select from availableI am NOT personally or closely related to a potential competitor of the listing for which I am inquiring.I AM personally or closely related to a potential competitor of the listing for which I am inquiring.Do you require roll-over equity, contingent payments or expect the seller to provide financing in excess of 10%.*Select from availableYesNoI am a business broker/intermediary/advisor* Yes No Client Name* Client Email* HiddenListing Interest HiddenListing URL HiddenListing ID HiddenListing Price HiddenBroker First Name HiddenBroker Last Name HiddenBroker Email HiddenBuyer Referred Working With Real Estate Agents Disclosure (For Buyers) IMPORTANT This form is not a contract. Signing this disclosure only means you have received it. In a real estate sales transaction, it is important that you understand whether an agent represents you. Real estate agents are required to (1) review this form with you at first substantial contact - before asking for or receiving your confidential information and (2) give you a copy of it after you sign it. This is for your own protection. Do not share any confidential information with a real estate agent or assume that the agent is acting on your behalf until you have entered into an agreement with the agent to represent you. Otherwise, the agent can share your confidential information with others. Note to Agent: Check all relationship types below that may apply to this buyer.Buyer Agency Buyer Agency: If you agree, the agent who gave you this form (and the agent’s firm) would represent you as a buyer agent and be loyal to you. You may begin with an oral agreement, but your agent must enter into a written buyer agency agreement with you before making a written offer or oral offer for you. The seller would either be represented by an agent affiliated with a different real estate firm or be unrepresented. Dual Agency & Designated Dual Agency Dual Agency: Dual agency will occur if you purchase a property listed by the firm that represents you. If you agree, the real estate firm and any agent with the same firm (company), would be permitted to represent you and the seller at the same time. A dual agent’s loyalty would be divided between you and the seller, but the firm and its agents must treat you and the seller fairly and equally and cannot help you gain an advantage over the other party.* Designated Dual Agency: If you agree, the real estate firm would represent both you and the seller, but the firm would designate one agent to represent you and a different agent to represent the seller. Each designated agent would be loyal only to their client.* Unrepresented Buyer Unrepresented Buyer (Seller subagent): The agent who gave you this form may assist you in your purchase, but will not be representing you and has no loyalty to you. The agent will represent the seller. Do not share any confidential information with this agent. Initials* *Any agreement between you and an agent that permits dual agency must be put in writing no later than the time you make an offer to purchase.Note to Buyer: For more information on an agent’s duties and services, refer to the NC Real Estate Commission’s “Questions and Answers on: Working With Real Estate Agents” brochure at ncrec.gov (Publications, Q&A Brochures) or ask an agent for a copy of it.Please verify that you are humanEmailThis field is for validation purposes and should be left unchanged.