Buyer Registration – Commonwealth Transitions

URL

This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

Password*

Enter Password Confirm Password

This field is hidden when viewing the form

RedirectTo

How did you hear about us?*

Job Title*

I would describe myself as*

Are you a U.S. citizen?*

Age*

Please enter a number from 0 to 120.

Home Address*

City*

State*

Zip*

Mobile Number*

Current Status*

Undergraduate School

Dental School*

Dental School Graduation Date*

Do you have an Active Virginia/DC Dental License?*

Specialty/Other Training*

Professional Experience

Associate

Military

Owner

Partner

Student/Residency

Type of Practice Opportunity you're seeking*

If you are a DSO, please list what organization you are with.*

Currently bound by Non Compete?*

Approximately how much is the operative production with your current employer?*

Have you ever owned a Dental Practice?*

What type of buyer are you?*

Region most Desired – 1st Choice?*

Region most Desired – 2nd Choice?*

City 1st Choice*

City 2nd Choice*

What type of environment would you like to most practice in?*

How flexible are you on location? (1-not at all, 10-extremely)

Please enter a number from 1 to 10.

What are your hobbies?

Would you be interested in a temp to purchase opportunity?*

What do you estimate your FICO score to be? (We recommend myfico.com, as a secure way to find this, however Experian score will suffice).*

Have you pre-qualified to purchase a dental practice by a specific Dental lender?*

If you have been pre-approved, which lender?*

If you have been pre-approved, how much have you been pre-qualified for?*

Attorney First Name*

Attorney Last Name*

Attorney Email*

Attorney Phone*

CPA First Name*

CPA Last Name*

CPA Email*

CPA Phone*

Confidentiality Agreement

By submitting this electronic form, I hereby agree not to disclose the name or circumstances of any parties introduced by Commonwealth Transitions LLC. I agree that all information provided by Commonwealth Transitions LLC regarding Dental practice opportunities is confidential and I hereby agree not to disclose to anyone or to make copies of any of the information, ideas, procedures, programs, concepts, contract and/or other data conveyed and entrusted by Commonwealth Transition LLC without the prior written consent of Commonwealth Transitions LLC. In addition, Commonwealth Transitions LLC and the Seller request that any projections, calculations, descriptions, and tangible material given will be immediately returned to Commonwealth Transitions LLC and/or destroyed. When a visit is coordinated between a buyer and a seller/client, Commonwealth Transition LLC requires feedback from prospective buyers on the visit out of respect to our seller/client and to ensure the best possible experience for all. I acknowledge and agree that any and all direct communications with seller and/or legal clients of Commonwealth Transition LLC must be approved and acknowledged by Commonwealth Transition LLC beginning from the initial introduction through closing. By submitting this form, I agree to the above terms, and acknowledge this will be considered equivalent to a signature. I consent to receiving updates on new listings via text and email campaigns from Commonwealth Transitions. I understand that standard data rates may apply to text messages sent from Commonwealth Transitions. I understand that I can expect anywhere from 3-10 text messages per month from Commonwealth Transitions. To opt out of this service please email info@commonwealthtransitionsflywheelsites.bwpsites.com to be removed from our Marketing list.

I have read and agree to the Confidentiality and Consent Agreement.*

Confirm

Untitled