EmailMe Form - C&S ASSOCIATES - INITIAL VALUATION QUESTIONNAIRE

===== COMPANY IDENTIFICATION =====

Company's full legal name *

Describe what the Company does? *

Examples: Service and Sales of Electric Motors and Generators. Financial Services, Wholesale Distribution, Retail Sales

Year Company founded

Year Company incorporated

Type of organization *

Incorporated (or registered) in what state *

===== VALUATION INFORMATION =====

Describe exactly what is being valued, e.g. 100% of the Company, 25 shares of Company, etc. *

Describe the purpose of this valuation, e.g. business sale, buy-out partner interest, estate planning, succession planning, estate settlement, divorce, etc. *

Select the premise of Value *

Operating as a "going business"

Liquidation, i.e. sale of all the assets and closing of business

Assemblage of Assets: Company is in the startup phase and not yet formally open for business.

Other

What is the “as of” date of the valuation? *

MM / DD / YYYY

Often the last day of the most recent fiscal year is used, e.g. 12/31/2011. Valuations made at the end of a fiscal year date usually have a lower cost as there are less accounting adjustments needed.

However for certain legal and business transaction purposes, the date of valuation may a date of death, a date of separation or divorce, an original or subsequent investment date for an ESOP or QES plan, etc.

Describe any restrictions or limitations in the scope of work or data available for analysis, if any

Examples: Premises cannot be entered. No financial statements available, etc.

Has the Company being valued any subsidiaries or affilliate companies that need to be considered? *

No

Yes

Other

List all owners: names, year of birth, and the number of shares or percentage of the total Company owned by each. *

Does the owner(s) have any ownership interest in other companies or businesses that do business with the Company being value? See next question for real estate related to the Company. *

Yes

No

Other

Who owns the real estate? *

Company

Leased from owner(s) separately

Arms-Length Third Party

Other

Are there buy out contracts between the owners or between the Company and the owner(s)? *

Yes

No

Other

Have there been any sales or transfers of stock or partnership interest in the last five years? *

Yes

No

Other

Last year's total sales *

Last year's reported profits - pre-tax? *

What is the owner's salary for the 12 month period prior to the date of valuation? *

If there is more than one owner, enter just the largest salary. If there are equal salaries for more than one owner, just enter one salary.

Estimate what percentage of the total sales were to your largest customer? *

If your business is a franchise or licenesee, what is the name of the franchisor or licensor?

Describe any proprietary intangilble assets owned or controlled by the Company.

Examples. Patents, trademarks, goodwill already on the financial statements, exclusive territories, exclusive product distribution rights, etc.

Is the Company current and in good standing with all regulatory, tax, environmental, and other government agencies at the local, state and federal levels? *

Yes

No

Other

Are there any lawsuits threatened, pending, or in progress against the Company or its owners as representatives, officers or employees of the Company? *

Yes

No

Other

As of the date of valuation, how many full time employees were on the payroll? *

Is the Company union or non-union? *

Non-Union

Union

Other

Choose the most appropriate option for the annual financial statements. *

Audited

Reviewed

Compiled on the GAAP basis by CPA

Complied on a Tax Basis by CPA

Internally prepared statements only on a GAAP basis

Internally prepared statements only on a tax basis

Mixed or Other

GAAP is generally accepted accounting principles.

If the date of valuation is not a fiscal year end, how are the interim statements prepared? *

Compiled on the GAAP basis by CPA

Complied on a Tax Basis by CPA

Internally prepared statements only on a GAAP basis

Internally prepared statements only on a tax basis

Other

Other Information

Provide any additional information that you think is relevant to the valuation.

===== Contact Information =====

Contact name *

First Last

Doing business as

Enter alternative business names, if any.

Legal address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

SIC or NAICS Code(s)

Company phone *

### - ### - ####

Cell phone

### - ### - ####

Preferred number to call

Company

Cell

Email address to send confidential information *

Confirm

Company web site

==== Financial Data =====

Financial questions will be forthcoming after review of the data below. Financial data that will be needed include:

Financial statements: balance sheets and income statements for the last five fiscal years.

If the date of valuation is not the end of the most recent fiscal year, then an interim year-to-date income statement up to the date of valuation with a comparison to the prior year-to-date up to the date day and month, and a balance sheet as of the date of valuation.

Federal tax return for the last fiscal year.

Depreciation schedule / Fixed Asset List

List of all loans to the Company including balance, interest rates, payment terms, collateral and names of guarantors. (Not needed if listed in CPA prepared statements.)

Any prior business valuations in the last five years, budgets, annual financial plans, short and/or long term strategic plans