MWI Practice Lead Form
Territory Manager
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First Name
Last Name
Territory Manager E-mail
*
Account Number:
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Account Name:
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What was the practices full year revenue for the previous year?
*
How many FTE veterinarians work at the practice?
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Does the practice own or rent the building?
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Own
Rent
Does the practice own the real estate on which the building is located?
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Yes
No
What is the timeline for the sale of the practice?
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Is the owner interested in a partial sale? [example: 50/50 ownership venture]
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Yes
No
Does the current veterinary owner want to continue to work at the practice after the sale?
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Yes
No
What city and state does the veterinary practice reside in?
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Is the practice 100% companion animal or is it mixed animal?
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Companion Animal Only
Mixed Animal
Who is the best contact at the practice?
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First Name
Last Name
Contact's Phone Number:
*
-
Area Code
Phone Number
Contact's Email Address:
*
Additional Comments:
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