ESOP Feasibility Questionnaire

The purpose of this questionnaire (and a follow-up conversation with you) is to help us determine the preliminary viability of an Employee Stock Employee Ownership Plan for your company. All responses will be held in strictest confidence. There is no fee associated with you furnishing this information or our initial contact with you.

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. For the last four questions A, B, C, and D please rank in order of importance from 1 to 4.

* Company:
* First Name:
* Last Name:
* Job Title:
Address:
City:
* State:
Postal Code:
* Phone:
Extension:
* Email:
Description of Business:
Fiscal Year End:
Type of Corporation:
Headquarter Location:
How many shareholders are there?
Minority/Woman-owned business?
Is there more than one class of stock?
Do you have a 401k program?
If yes, is there a company match?
Do you have a profit sharing program?
Number of full time employees?
Do you have a union?
Do you have any Foreign Subsidiaries with employees?
Approximate Annual Revenues?
Please rank the following in order of importance:
A. Selling part or all of my stock now
B. Selling part or all of my stock within 10 years
C. Buying back stock from other shareholders
D. Increasing employee incentive and productivity