New Listing Service

I,

First Name

Last Name

hereby acknowledge and agree that all information pertaining to practice(s) that I am introduced to by ROI Corporation, shall be obtained only through ROI Corporation, and that I WILL NOT CONTACT THE OWNER(S), STAFF, PATIENTS, or other advisors of the practice(s), unless I am ACCOMPANIED BY AN ASSOCIATE OF ROI CORPORATION, the Exclusive Agent for the Vendor(s). I further agree not to write or mark the Appraisal(s), nor shall I copy or reproduce any information in any manner whatsoever without the prior consent of ROI Corporation.

I understand and agree that any information supplied to me is as a SERIOUS PROSPECTIVE PURCHASER and that all information, including the VENDOR'S NAME, the location of the practice , financial details, and all other information pertaining to the practice and its operation, are STRICTLY CONFIDENTIALand for my own personal use, and with prior consent from ROI corporation, for use with my accountant, bank and or other financial institution for the purpose of assessing the viability of acquiring said practice and for obtaining funds for such acquisition. I will inform these parties of this agreement of confidentiality before disclosing the information supplied.

I acknowledge and agree that all negotiating, drafting and presentations of offers shall be handled through ROI Corporation, as AGENT FOR THE VENDOR, on ROI Corporationís standard offer documentation and that my lawyer will be provided with a copy of said offer(s) for review prior to my signature.

Please ensure that all contact information provided is confidential.

Date

First Name *

Last Name *

Phone *

Email *

Street *

Unit/Suite

City *

Province *

Postal Code *

Profession *

I am *

University *

Year Graduated *

Specialty

Other Profession *

Choose a ROI associate to speak with

Where would you like to practice? *

How did you hear about us? * How did you hear about us?

Register for the New Listing Service (NLS)?

Yes

I would like to receive future messages about special offers, news and event information

Yes

Please note that it may take up to 24 hours to receive NLS info. For immediate assistance, please contact the listing sales representative.

Date

CONFIDENTIALITY AGREEMENT

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