Rep & Warranty Insurance Form - Heritage Insurance Advisors

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(614) 319-3501

Rep & Warranty Insurance

Please fill out this form so that your Rep & Warranty Insurance expert is best prepared to help you.

Step 1 of 2

50%

Name

First Last

Phone

Email

What Type of Policy Will You Need?(Required)

Buy-Side

Sell-Side

Please select one option

Has the Bidder Reached Exclusivity?(Required)

Yes

No

Please select one option

Expected Signing Date:(Required)

Expected Closing Date:(Required)

Purchase Price/Enterprise Value:(Required)

Escrow Terms:(Required)

Dollar amount/time period (i.e. 10%/$3,000,000/24 months)

Name of Seller:(Required)

Type of Seller:(Required)

Founder

Private Group

Family Office

Private Equity

Please select one option

Brief Description of Target Entity:(Required)

Seller’s Counsel:

Name of Buyer:(Required)

Type of Buyer:(Required)

Strategic

Financial

Private Equity

Please select one option

Brief Description of Buyer:(Required)

Buyer’s Counsel:

Please be prepared to provide the following documents once you connect with your expert.

Confidential Information Memorandum (CIM) or similar document (e.g. management presentation, etc.)

Financial Statements of the Target Entity

Quality of Earnings

The Purchase and Sale Agreement

Please select the documents you will be providing.

What 3rd Party and/or Internal Due Diligence Has Been or Is Expected to Be Performed?(Required)

Pleaser provide a brief description.

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Heritage Insurance Advisors

4653 Trueman Blvd, Suite 122
Hilliard, OH 43026

cbara@hia-oh.com
service@hia-oh.com
614-319-3501 (Office)
614-450-0674 (Fax)