Register As Dental Buyer | Dental Transition Profile

Thank you for inquiring about one of our dental practices.

Banks these days want to know details about a buyer’s personal financial situation along with their production ability. If we can provide this information to them, it can make the entire process go more smoothly, which may result in a quicker approval. PLUS, we will be able to send you ideal dental practices based on your preferences when they com available.

Please take a few minutes to provide the information requested below to help us better determine your cash flow needs.

Matt Scherer

General

* fields are required.

First Name:*

Last Name:*

Email:*

Mobile Phone Number:*

Date of Birth:

Month

Day

Year

Are you a US Citizen?

Secondary Email:

If your Spouse will be the primary contact, please provide us with their information. Spouse's Full Name:

Spouse's Email:

Spouse's Mobile Phone:

What is your current status?

How many years have you been in the above status?

Dental School Attended:

Graduation Year:

Degree:

Practice Criteria

What practice types are you interested in? (Please check all that apply.)

General

Endodontic

Oral Surgery

Orthodontic

Pediatric

Periodontal

Prosthodontic

What transition types are you interested in? (Please check all that apply.)

Practice for Sale

Practice Merger

Associateship

Partnership

Facility for Sale

Real Estate for Sale

What is the ideal number of operatories you want in the facility?

What is the ideal amount of annual collections you want for the practice?

What is the furthest commute you would consider?

Professional Advisors

Are you working with another broker?

Which lenders have you already contacted about financing?

Do you have an accountant?

Do you have an attorney?

Do you have an insurance agent for Life & Disability?

Questionnaire

Have you ever filed for bankruptcy?

Assets

Cash on hand and in banks

Marketable securities (stocks, bonds, non‐retirement funds)

Pension, 401k, IRA or other retirement funds

Liabilities

Credit Cards

Auto Loans

Student Loans

Mortgage Loans

Unpaid Bills

Other Liabilities

Electronic Signature

Full Legal Name: *

Date: *

By checking this box, I agree to all of the following:

To the best of my knowledge, all of the information provided is accurate and correct.
To the terms, conditions, and confidentiality of information set forth by PMA's Non-Disclosure Agreement located here: https://pmagroup.net/wp-content/uploads/PMA-Agreement-Final.pdf.
That such action is an electronic substitute for my signature on this form.
The information provided in this form is intended to be and will be disclosed to persons (including corporations, partnerships, firms, lenders and other individuals) for the purposes contemplated and that PMA shall have no liability for any claims, demands or action arising in connection herewith.

Please email when new practice opportunities become available.

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Register As A Buyer

General

Practice Criteria

Professional Advisors

Questionnaire

Assets

Liabilities

Electronic Signature