Company
* First Name:
Last Name
Job Title
Address
City
State
Zip Code
Country
* Phone
* Email
* Description of Business:
* Fiscal Year End
Type of Corporation:
* Headquarter Location

ESOP objectives and rank in order of importance:

a. Selling part or all of my stock tax free now

 
b. Selling part or all of my stock tax free within 10 years
c. Buying back stock from other shareholders with tax deductible dollars
d. Increasing the value of the stock that I keep
e. Cutting corporation taxes and increasing cash flow
f. Increasing employee incentive and productivity

List all stockholders/ shares(percent)/ title or inactive/ age

Is there a shareholder buy-sell agreement?

Is there more than one class of stock?
* Is there voting and non-voting shares?
Have there been substantial, recent changes of ownership?
If so, please describe:
Do you have a 401k program?
If yes, is there a company match?
Do you have a profit sharing program?
If yes, how much was last year's contribution?
Do you have other Qualified Retirement Programs?
If yes, what kind?
Do you have a Simple IRA?
Do you have a Model SEP?
Do you have a SEP?
Do you have a cash bonus program?


List of the number of full time employees (w-2 with more than

* Total Full Time Employees:

1000 hours of service)
* How many are Shareholders?
* How many are Union?
Do any of these employees work for foreign subsidiaries?
* Number of Locations

* For this fiscal year and last fiscal year, please indicate approx.

revenues, & pre-tax earnings.

* Please describe and provide the amount of any unusual items or

non-recurring expenses that, if added back to the pre-tax income, would

provide a more accurate indication of the company's earnings capacity.

Balance Sheet Debt:

* Outstanding short term Line of Credit

* Outstanding long term Debt (include current portion:)

Company Value:

* Your estimate of Total Company Value:

* Date of most Recent Appraisal
* Purpose of most Recent Appraisal
* Equity Value of most Recent Appraisal
Total Payroll







 

 

 

 

 

 

 

 

 

 

 

 

 

 

 The purpose of this questionnaire is to help us determine the preliminary viability of an Employee Stock Ownership Plan for your company. All responses will be held in strictest confidence and will not be disclosed to anyone outside our firm without your expressed consent.
You shall be under no obligation to pay any fees as a result of your furnishing this information. Fees would only be payable pursuant to the execution of a formal agreement, if any.

Please complete all applicable entries, and hit the submit button at the bottom of the page. One of our Managing Directors will contact you shortly thereafter to discuss how ESOPs are designed and how they may be useful to your situation.