Practice seller registration form

Personal details
Title:
First Name:  *
Last Name:  *
Mailing address
Street:  *
Suburb / Town:  *
State:  * (only if country is Australia)
Postcode:  *
Country:  *
Practice address
Same as 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 description
Practice type: Sole Principal   Associateship *
Number of surgeries:
Equipped:
Rooms suitable for operatory:
If Associateship:
Number of full time associates:
Number of part time associates:
Employee Dentists:
Number of full time employee dentists:
Number of part time employee dentists:
Any additional information:
Figures
Monthly premises rental: $
Gross Income Figures
2005-2006: $
2006-2007: $
2007-2008: $
Current financial year: $   until end of  
Price
Equipment and materials: $
Goodwill: $
Total: $
Reason for selling
Details:
Other information
Details:
Services
All fees are GST inclusive and in $AUD
Free practice sales promotion listing on the DJS website. Note if you accept this offer DJS reserves the right to invoice the vendor fee upon Sale of Practice
Advertising on DJS Website at $1,100.00 for large Feature Advertisement placed in a prominent position. Note: Vendor fee no longer applies.
Written Practice Valuation at $1,650.00 - Practice Valuation Forms available on this site.
Consultation / Facilitation on:
  • Marketing strategies
  • Practice assessment and comparison with current market place
  • Negotiations including contractual, lease and handover matters plus interaction with Vendor, Purchaser, Solicitor and Accountants as required.
  • Exploration of options following the sale of your 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.
Special promotion of position
Please tick the box if you wish to get more information on how DJS can help you with:
  • Advertising in National Newspapers, ADA Bulletin/ Journal & Overseas Professional publications - preparation & placement of advertisements and receipt of enquiries
  • Special targeted promotions including preparation of promotional material & receipt of responses
  • Price on Application
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).
DJS Practice sale service and vendor agreement
Click here to read our Practice Sale Service and Vendor Agreement.
I acknowledge and agree to the DJS Practice Sale Service and Vendor Agreement. *
I certify that the information supplied on this date is, to the best of my knowledge, totally accurate. *
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.

VIC, metro, $90,000.00
VIC, metro, $930,000.00
VIC, metro
NSW, country, $100,000.00
QLD, coastal, $200,000.00
NSW, coastal, $110,000.00
NSW, coastal, $220,000.00
NSW, metro, $250,000.00
NSW, country, $235,000.00
NSW, metro
VIC, metro, $55,000.00
VIC, country, $300,000.00
NSW, coastal, $350,000.00
NSW, coastal, $175,000.00
QLD, country, coastal, $245,000.00
QLD, coastal, $700,000.00