Non-Circumvention Non-Disclosure Agreement

Corporate Office: 711 W. 17th Ste #J5, Costa Mesa, CA 92627

New York Office: 45, Oriole Way Dix Hills, NY 11746

Phone Number: (888) 277-6633

In order to maintain the confidentiality and integrity of the practice sale, it is necessary to forward an executed and completed Non-Circumvent Non-Disclosure Agreement ("Agreement") to ProMed Financial, Inc. ("ProMed"). Upon receipt, detailed information will be provide for your review. Please complete the entire form so that we can provide all services available through ProMed.

BUYER STATUS

Please Indicate Your Position as a Buyer:
Click all that apply
Select all that apply
Yes or No

General Information

TERMS AND CONDITIONS

*

I have read the Terms & Conditions provided by the company and agree to abide by all the Terms & Conditions as stated in this Agreement.

Clear
Draw Signature into box.