First Name:
Last Name:
Title:
Company Name:
Company Address:
City:
State:
Country:
Zip Code:
Email Address:
Phone Number: 
Cell Phone:
Fax Number:

Best way to contact:

Email 

    Phone

Fax    

    Mail

 Acquisition Criteria:

Adult Day Care
Nursing: Private Pay
Rehab / Custom      Wheelchairs

Assisted Living
Nursing: Medicare
Rehab / Sports      Medicine

Distributor
Orthotics and      Prosthetics
Respiratory      Equipment

Durable Medical      Equipment
Pharmacies - OTC
Sleep Clinics

Infusion Therapy
PT/OT Practices
Staffing Company

Manufacturer
Physician Practices
Supplies

Nursing Homes
Other 

 Size of Company (based on annual revenue)
 

 Min. $   Max. $


 Desired Geographic Location:

 (Use the CTRL Key to make multiple selections)
 

Please send me a general description of companies for sale, exclusively represented by Ultimate Resource
 

 Comments/Questions:

 
 
 
 
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