2. Insert your name in blank

3. Complete information and sign

4. Mail or fax to Roy Berry Consultants

ROY BERRY CONSULTANTS & PRACTICE BROKERS
6602 E. 91st Street
Indianapolis, Indiana 46250

1.800.659.6117 FAX 317.841.3162

ROY BERRY CONSULTANTS & PRACTICE BROKERS

NON-DISCLOSURE/NON-CIRCUMVENTION AGREEMENT AND DISCLAIMER

I the undersigned, ______________________________ hereby agree not to discuss or disclose to any third party, except my attorney and tax advisor, and to keep completely confidential all names of any corporation, organizations, individuals or groups of individuals introduced by ROY BERRY CONSULTANTS & PRACTICE BROKERS. The undersigned further agrees not to disclose any facts learned about the business to any third party, including employees, customers, suppliers or other prospective buyers. The information and/or records about these businesses obtained by the undersigned shall not be used for competitive use in any business, present or future. It is understood that the information disclosed to others could cause a loss of business, and/or create injury in employee/employer relationships. The undersigned agrees to caution their attorney and tax advisor as to the need for confidentiality in handling the information that will be provided them and to seek their help in maintaining the confidentiality agreement. If the undersigned decides not to pursue the proposed transaction, he/she will promptly advise ROY BERRY CONSULTANTS & PRACTICE BROKERS of this fact and return all proprietary information without retaining copies or extracts thereof.

The undersigned or his representative further agrees, promises and pledges that neither it nor any principals, officers or agents shall circumvent and further shall not make any contact directly or indirectly or attempt to otherwise deal with any sources being revealed by ROY BERRY CONSULTANTS & PRACTICE BROKERS.

The transaction which you are contemplating will naturally involve a variety of financial statements and legal documents that bear significantly on your decisions. Our firm does not intend to represent that any of the financial statements or any other material or information supplied by the seller or its agent have been inspected, verified or approved by us. It is because we recognize the significance of this data that we recommend an independent certified accountant of your choice. In addition, for your protection, we request that your legal counsel be available to assist you throughout the transaction.

The undersigned acknowledges the recommendation of ROY BERRY CONSULTANTS & PRACTICE BROKERS that he/she engage independent professional assistance to assist him/her in evaluating whether to pursue a practice. ROY BERRY CONSULTANTS & PRACTICE BROKERS is the agent of the selling dentist.

ROY BERRY CONSULTANTS & PRACTICE BROKERS is authorized to obtain consumer credit reports.

AGREED TO AND ACCEPTED ON DATE SIGNED:

Date:

By:

Printed:

Address:

By:

SSN:

Telephone#:

Address where we can send any correspondence:

School Graduated From:

Year Graduated:

{ Home }