Public Company Services - Go Public, Raise Capital, Do Mergers and Acquisitions

Tell us something about your public company on the form below. Please give us as much information as possible so we can better assist you:

First Name:	*
Last Name:	*
Company Name
Your position
Address:

City:
State:
Zip Code:
Country
Phone Number
Fax Number
Cell Number
Email Address:	*
Website URL
What does your company do?

Symbol
Traded on which exchange?
Are your filings current?
State Incorporated
Date Incorporated
Common Shares Authorized
Common shares issued & outstanding:
Free Trading Shares
Restricted Shares
Restricted Shares - 144k eligible
Preferred Shares Authorized
Preferred shares issued & outstanding:
Number of shareholders currently (approximately):
Number of shares held by control persons

Approximate Revenues (this year):
Last years revenues:
Next years revenues:
Approximate Annual Net Earnings:
Approximate Total Assets
Approximate Total Liabilities
Do you have audited Financials?
Date of last audit
Reporting Company?
Last Report filed
Date last operated business
Miscellaneous Information (or enter your executive summary)
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