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Going Public: Confidential IPO Information Questionnaire
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It is critical that you seek the counsel and representation of an experienced securities lawyer to guide you through the process of launching your initial public offering. In order to do the best possible job on your behalf, your attorney needs information about you and your company. At your first substantive meeting with your securities lawyer, you should be prepared to provide, as applicable, the following information:
INFORMATION ABOUT YOU | |
| Business Address | ____________________________ |
| ____________________________ | |
| ____________________________ | |
| Work Phone Number | ____________________________ |
| Other Phone Number | ____________________________ |
| Facsimile Number | ____________________________ |
| E-mail Address | ____________________________ |
| Have you ever declared bankruptcy, been accused, convicted or found liable for any violation of a federal or state securities law or regulation, or entered into a consent decree with, or had an injunction granted against you by, any federal or state enforcement agency or commerce department? (If yes, provide details) | Yes_____ No_____ |
INFORMATION ABOUT YOUR BUSINESS PARTNER(S) (Your business partners, if any, should provide the same information you have provided above)
INFORMATION ABOUT THE COMPANY
| |
| Name of Company | ____________________________ |
| Business Address | ____________________________ |
| ____________________________ | |
| ____________________________ | |
| Phone Number | ____________________________ |
| Facsimile Number | ____________________________ |
| E-mail Address | ____________________________ |
| Web Site Address | ____________________________ |
| ____________________________ | |
| Is the business incorporated? | Yes_____ No_____ |
| In what state is the business incorporated? | ____________________________ |
| Is the corporation in good standing in the state of incorporation? | Yes_____ No_____ |
| List any other states in which the corporation is authorized to conduct business: | ____________________________ |
| Is the corporation presently a Subchapter S corporation? | Yes_____ No_____ |
| Has the company adopted any bylaws? (If yes, provide a copy) | Yes_____ No_____ |
| Does the corporation presently have any stock option or stock purchase plans? (If yes, provide copies) | Yes_____ No_____ |
| Have you maintained a corporate records book for the corporation? (If yes, provide the book to your attorney for inspection) | Yes_____ No_____ |
Who are the current owners of the business, in what percentages, and for what contributions? Owner Percentage of Ownership Contribution __________________ _______ ________________________ __________________ _______ ________________________ __________________ _______ ________________________ __________________ _______ ________________________ List the officers of the company: Title Name Address Phone Number _______________ _______________ _________________ ________________ _______________ _______________ _________________ ________________ _______________ _______________ _________________ ________________ _______________ _______________ _________________ ________________ | |
| Have any of the officers ever declared bankruptcy, been accused, convicted or found liable for any violation of a federal or state securities law or regulation, or entered into a consent decree with, or had an injunction granted against them by, a federal or state enforcement agency or commerce department? (If yes, provide details) | Yes_____ No_____ |
List the members of the board of directors of the company: Name Address Phone Number _________________ __________________ _________________ _________________ __________________ _________________ _________________ __________________ _________________ _________________ __________________ _________________ _________________ __________________ _________________ | |
| Have any of the directors ever declared bankruptcy, been accused, convicted or found liable for any violation of a federal or state securities law or regulation, or entered into a consent decree with, or had an injunction granted against them by, any federal or state enforcement agency or commerce department? (If yes, provide details) | Yes_____ No_____ |
| Who is the chairperson of the board of directors of the company? | ____________________________ |
| Are there any written or unwritten compensation arrangements or contracts between any officers or directors of the company and the company? (If yes, provide your attorney with a copy) | Yes_____ No_____ |
| Do you have a written Business Plan? (If yes, provide your attorney with a copy of it) | Yes_____ No_____ |
Describe your present business operations: Describe your intended business operations post-IPO: How much money do you believe you need to raise to achieve your business growth objectives? __________ | |
| Have you offered to sell or sold any interests in your business to any investors (for instance, in a private placement)? (If yes, provide details) | Yes_____ No_____ |
| Have you retained any consultants, accountants or tax professionals? (If yes, provide names, addresses, phone numbers, and details) | Yes_____ No_____ |
| Is the business a party or potential party to any joint venture, license or similar agreement? (If yes, provide your attorney with a copy) | Yes_____ No_____ |
| Does the business own or lease any real estate? (If yes, provide details) | Yes_____ No_____ |
| Does the business have any written financial statements? (If yes, provide your attorney with copies of the statements for the past three years) | Yes_____ No_____ |
| Have the financial statements been audited? | Yes_____ No_____ |
OTHER QUESTIONS (Make a list of pertinent questions to ask your securities attorney) | |
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