Potential Partner Survey

Potential Partner

RXScalePartners.Com
Company Name*
Contact Email*
example@example.com
Company Contact Name*

First NameLast Name
Contact Position (Title) *
Owner - CEO - COO
Contact Phone Number*

Area CodePhone Number
What states do you operate in? (Select All That Apply)*

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington(Washington DC)West VirginiaWisconsinWyoming
What states are you looking to acquire in (Select All That Apply)*

No warehouse LocationsAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington(Washington DC)West VirginiaWisconsinWyoming
How long has the company been in business?*

Less than 2 years2-4 Years4-8 yearsMore than 8 yearsOther
Target Acquisition Date.
Do you have an acquisition plan in place? *
How soon would you be able to execute a partnership?

MonthDayYear
Date
What type of Practice are you looking to acquire:
Should be Empty: