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Feasibility Questionnaire  
Download Questionnaire
Client Advisor Information
           
Name:   City  
Address:   State/Zip:  
Phone:   Fax:  
Email:        
           
Client Contact Information
           
Corporation Name   Year Established:  
Address:   City:  
Phone:   State/Zip:  
Email:   Fax:  
CEO:   Website:  
Contact Name:   CFO:  
CPA/Tax Advisor:   Title:   
Business
Description:		   SIC Code:  
Type of Incorporation:   C Corp  S Corp  Other    
           
Capitalization
     
Stock Class Total Authorized Shares Total Outstanding Shares
     
Common:
Other Common
Preferred:
     
Stock Ownership. Please complete the information for each stock class
           
Common Stock:          
Owner Name Shares % of Co. Age Employee? Years of Service
           
Other Common Stock          
Owner Name Shares % of Co. Age Employee? Years of Service
           
Preferred Stock          
Owner Name Shares % of Co. Age Employee? Years of Service
           
Is any of this stock issued through stock options? Yes No
           
Gross Annual Payroll          
Employee Type   Payroll   Number of Employees
Non Union:   $  
Union:   $  
Total:   $  
           
Does the company have subsidaries or any "brother/sister" corporate relationships?
Yes No If yes, please explain:
       
Qualified Plan Information
Type of Plan Employer Contribution Employer Contribution Current Assets
   
Financial Data  
   
Fiscal Year End
Estimated Fair Market Value of this business (FMV)?
What is the basis of FVM
What is the estimated growth in gross revenue over the next 3-5 years?
   
Please list potential successor management for the company.
   
   
Please list family members at the company.
   
   
Corporate and Personal Objectives (Please prioritize: 1 = most important)
   
Cash out one or more shareholder and avoid capital gains tax
Which one(s)?
Sell or merge the company
Retire Immediately: Next 5 Years: 10 Years or more:
Infuse working capital into the company
Acquire another company with pre-tax dollars
Sell company to management group with tax advantages to both buyer and seller
Get equity into the hands of employees with shareholder & company tax benefits
Induce employees to remain with the company
Attract executives to join the company
Create private market for company stock
Refinance existing debt making both principal & interest tax deductible
Increase employee productivity and thereby increase company profitability
Improve the effectiveness and reduce the cost of employee benefits, including pensions and profit sharing plans.
   
Comments about Priorities:
   
Initial Documents Requested
 
1.  Three years of financial statements plus most current year-to-date
2.  One copy of this completed questionnaire
3.  Employee Census including at least the following information about each employee:
  • Name (or employee number)
    		•
  • Sex
    		•
  • Date of Hire
    		•
  • Date of Birth
    		•
  • Current W-2 Compensation
    		•
  • Contributions to 401(k) Plan and Employer Match
    		•
  • Contributions to Other Defined Contribution Plans (if any)
    		•
     
    NOTE: Are there any adjustments that should be made to the financial statements that are not currently reflected in the statements; which might impact the stock value?
     
    Yes No If yes, please explain:
     
    Confidentiality Agreement Relating To The Disclosure Of Financial Information
     
     
    *Accepted and Agreed:
     
    *Your Email Address: @ .
    *= required
     
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