City:
State:
Zip Code:
Name of Company contact person:
Telephone:
Fax:
Email:
1. Date Company started:
No. of owners or shareholders:
2. Gross Revenue 2005: $
Net income 2005: $
3. Gross Revenue 2006: $
Net income 2006: $
4. Revenue est. for 2007: $
Est. Net 2007: $
,,,.
Revenue est. for 2008: $
Est. Net 2008: $
5. Date business plan was prepared or last revised:
6. Date of last financial audit:
7. Date of last debt financing:
Amount: $
8. Date of last equity funding:
Amount: $
9. Total liabilities owed in less than one year: $
....Owed in more than one year: $
10. Describe the products and/or services offered by the Company:
11. Describe the competitive advantages over other companies offering a similar product or service (including patents or patents pending):
12. Other than lack of capital, list what other challenges the Company needs to address in order to meet its sales goals for the next 12 months:
13. List at least six significant accomplishments of the Company during the previous 12 months:
14. Describe the business experience and track record of the Company's CEO that would lead investors to believe that upon funding the Company future revenue / net income projections can be realized in a
timely manner:
15. Describe any current or threatened lawsuits against the Company or its principals:
16. List any other additional information that is important to consider regarding the Company or its principals:
17. Asking price for the company $ , or if looking for investment capital, the amount of funds being requested:
$ .
Is this for equity, debt or a combination of both:
18. Describe how the new investment funds will be used during the next 12 months to grow the Company:
19. Funds are sometimes placed by multiple parties, are there any parties you prefer not to work with: Yes No
If yes, describe the parties you do not wish to work with:
20. If you are a private company or foreign listed public company, are you open to being listed as a publicly traded company in the U.S. as a condition of your funding:
Yes No
