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Company Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
................................................... 5. What sector does your companies in any of the
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If you are not the CEO, please business operate in? following areas?
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Telephone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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2. What level of turnover box3 Solicitor
growth did your company 6. Please tick the boxes below
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achieve in the financial if you are considering any box3 M&A specialist Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Payment method
box3 0-4.9% AIM, PLUS or the
box3 5-9.9% London Stock Exchange ...................................................
Invoice box3 Cheque box3 Credit card box3
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Card number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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CCV number (last 3 digits on signature strip) . . . . . . . . . . . .
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Expiry date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
box3 >50% box3 Making an acquisition in
the next 2-3 years
Type (Mastercard/Visa/Debit card) . . . . . . . . . . . . . . . . . . . .
3. What is your company’s box3 Raising equity finance in
Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
annual turnover? the next 3 years
box3 Up to £1m box3 Taking part in a
box3 £1m-£2.49m management buy-out in
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