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Indy Health Investor Request Form
Accredited investors who wish to be part of the Indy Health team should complete this brief questionnaire along with the Non-Disclosure Agreement (NDA). All responses will be confidential. Once this questionnaire and NDA Agreement are completed via Google Forms, someone from the Indy Health team will contact you for an in-depth presentation regarding the Indy Health offering. Please note, to complete the NDA, you must go back to the website and click on the NDA button after completing this Request form.
Email address *
First Name *
Your answer
Last Name *
Your answer
Alternate Email Address
Your answer
Phone Number *
Your answer
What state do you live in? *
Your answer
Do you own any pharmacies
If you own pharmacies, how many do you own?
What type of investor would you classify yourself as?
If interested in joining Indy Health as an individual investor, please indicate which of the following statements apply to you:
If you own a business and are interested in the business joining Indy Health as an investor, please indicate which of the following statements apply to you:
Have you completed and submitted the Non-Disclosure Agreement yet? Remember, both forms must be completed in order to qualify for the presentation.
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