Investor Investment Confirmation Form

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Deal Confirmation

You are about to invest at the valuation specified by the pharmacy you selected. Confirm amount you would like to invest into the pharmacy?

Equity % Selection

What equity % within 10-25% range are you offering for this investment?

Payout Preferences

Select your payout preference:

Investment Agreement

I agree to the 5-year payout structure with equity share as selected above

Yes, I agree

IMPORTANT NOTE BELOW:

Before submitting, please double check the answers you have provided in this form to ensure all information is correct and that you are confident in the offer you are making to the selected pharmacy you want to invest in.

Contact Information

First Name *

Last Name *

Phone *

Email *

Company / Investment Firm (if applicable) *

Website (if applicable) *

Linkedin URL *

Accreditation & Capital Readiness

Are you an accredited investor? *

What is your typical investment range per deal? *

Investment Preferences

Annual Revenue Range you prefer in a pharmacy investment target: *

Preferred Gross Margin Range (%): *

Preferred EBITDA Range (absolute $ value):

Preferred Net Profit Range (% of revenue):

Preferred Free Cash Flow Range ($ amount per year):

Risk Appetite *

What type of investor are you?

In what industries do you invest?

Deal Volume & Timeframe

How many pharmacy investments are you looking to make in the next 12 months?

What is your ideal investment timeframe once a match is found?

Additional Notes (Optional)

Is there anything specific you look for in a pharmacy investment?

Confirmation & NDA Notice

By submitting this form, you acknowledge that any opportunities presented are confidential and subject to our Non-Disclosure Agreement and Due Diligence protocols.