Buyer registration form

Personal details
Title:
First Name:  *
Last Name:  *
Mailing address
Street:  *
Suburb / Town:  *
State:  * (only if country is Australia)
Postcode:  *
Country:  *
Contacts
Business:  *
Home:
Mobile:
Business Fax:
Home Fax:
Email:
Preferred contact:
(to select multiple options press control/command & click again)
Preferred hours:
Practice Purchase Specifications
What kind of practice/s are you looking to buy?
Country State Specific Requirements
1:  *  *
2:
3:
I would like to receive email updates when a new practice gets added in a state I am interested in.
Services
All fees are GST inclusive and in $AUD
Please check the box next to the services you would like to register for.
I would like to be a Web Buyer:
  • 12 months
  • View updated 'practice for sale' listings through the website
  • Receive Practice contact details upon request by phone or email
  • AUD $99
Consultation / Facilitation services:
  • Checklist to help assess practice viability and potential
  • Experienced assistance with analysis of cash flows and projection of net income and profitability
  • Support and assistance with negotiations
  • Comparison of differing practice's potential and suitability
  • Assistance with sale contracts / finance sources
  • Successful marketing techniques to assist you to locate your ideal practice
Consultation rate $440 per hour

Hours required:
Payment details
Payment method:  *
Amount: $ 0.00
Please make cheques and money orders payable to Dentist Job Search P/L.
For all credit card payments, you will be redirected to our secure payment page once you click 'Submit' button. We accept MasterCard, Visa and Bank Card only.
Following receipt of your details and acceptance of provisions of the confidentiality agreement (below) you can now contact the DJS office for further information of practice locations and vendor's contact details.
How did you hear about us?
Free monthly e-newsletter subscription
Please check this box if you would like to be subscribed to Prime Practice's E-Newsletter (only for registrations that include an email address).
Confidentiality Agreement
Click here to read our Confidentiality Agreement.
I acknowledge and agree to the Confidentiality Agreement. *
Image Verification

If you can't read the code,
click here 		Please enter the five letters that appear in the image opposite. *

Fields marked with an asterisk (*) are compulsory.

TAS, metro, permanent
VIC, metro, permanent
NZ, metro,country, permanent
NZ, country, permanent
VIC, metro, permanent
VIC, country, permanent
ACT, metro, permanent
QLD, coastal, permanent
NSW, coastal, permanent
VIC, metro, permanent
QLD, coastal, permanent
VIC, metro, permanent
WA, country, locum