Did you read the Legacy
Confidentiality Agreement? *
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Yes |
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No |
What Legacy Business Planning Service
would you like to receive a Fast Track
Quotation for?
(You must highlight one service only) *
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Contact Information
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Your First Name: * |
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| Your Last Name: * |
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| Your Title: |
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Legal Name
of Business: * |
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| Telephone Number: * |
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| Fax Number: |
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| E-mail Address: * |
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| Company Website: |
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Background Information
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The year the Company
was established. * |
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Legal Structure: *
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Sole Proprietorship |
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Partnership |
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LLC |
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C-Corp |
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S-Corp |
Business SIC Code: *
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Business NAICS Code: *
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| Does the business own any intellectual property? (i.e. website, patents, copyrights, etc.): |
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| Number of Employees: |
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| Number of Locations: |
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Headquarter Location
(City, State, Country): |
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| Own or Rent facilities? |
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| Total square footage of facilities: |
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| Describe your Company's products/services: |
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| What industry do you compete in? |
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Do you compete...
(highlight one choice only)
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How would you characterize
your target markets? |
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What is your competitive advantage?
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Financial Information
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Accounting System
(Cash Basis or Accrual Basis): |
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| The frequency in which financial documents are generated (i.e. weekly, monthly, quarterly, semi-annually, annually.): |
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| Income/P&L Statement: |
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| Balance Sheet: |
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| Cash Flow Statement: |
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| Accounts Payable Aging: |
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| Accounts Receivable Aging: |
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2007 Sales:
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| 2007 Profit or (loss): |
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| 2008 Sales: |
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| 2008 Profit or (loss): |
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| 2009 Sales: |
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| 2009 Profit or (loss): |
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| 2010 Projected Sales: |
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| 2010 Projected Profit or (loss): |
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Which do you prefer, a capital
infusion of debt or equity? |
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How much capital do
you need to raise? |
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What will you use the capital infusion
for? (Itemize your list & assign a dollar value to each listed item)
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| List both your business and your personal assets and the market value of each asset that you can pledge as collateral? |
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Additional Information
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