NDA TEST PAGE

The undersigned party below wishes to evaluate confidential business information of various professional practice opportunities presented by Southeast Transitions, LLC. The undersigned agrees not to disclose to anyone the confidential practice information (other than any advisors of the undersigned, which shall then be bound by the same terms and conditions of this Nondisclosure Agreement). The nature of the dental transition business deals with highly sensitive and confidential data, including income tax statements, Proforma, the names of buyers and sellers and/or other tangible or intangible data conveyed and entrusted to the undersigned.

The Seller and Southeast Transitions LLC request that the undersigned return any projections, calculations, word descriptions, and tangible material to Southeast Transitions should they decide not to purchase the practice. The undersigned also agrees to delete any confidential data provided electronically through e-mails by the Seller and Southeast Transitions, LLC should he/she decide not to purchase the seller’s practice.

The undersigned has executed this Agreement on the day and year written above.

Name*

Email*

Title:*

DMD
DDS
Other

Please specify the Listing IDs of practices you are interested in:*

What is/are your other title(s)?*

Home Mailing Address:*

Street Address City State ZIP Code

Phone (Mobile)*

Phone (Other)

Fax*

How would you prefer to be contacted? (List all preferred.)*

Office Phone
Home Phone
Cell Phone
Email

What is your office phone number?*

What is your home phone number?*

What is your cell phone number?*

1st Choice of Area:*

2nd Choice of Area:*

3rd Choice of Area:*

Please attach a copy of your CV or resume. (Optional)

Drop files here or

Signature*

Today's Date:*