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PCMS-Team.com This site is not intended to provide legal or accounting advice and each reader should discuss the issues noted herein with their accountants or lawyers. PCMS works with experienced lawyers and accountants who can discuss these issues for issuers interested in using its services. This site is currently being updated and therefore some of the statements may not be timely.
Is Your Company Headed for a Compliance Crisis?
Find
Out in as little as 30 Minutes.
The Compliance
Checkup Open Line is a FREE, fast-moving 30 minute consultation
in which Stephen Brock will help you determine whether your
company needs professional compliance management. This consultation
normally costs $160.00. Appointments
are granted on a first-come, first-served basis.
The next open line day is scheduled for: Thursday, 30
Begin by filling out this form - what follows is a series of questions to determine your
potential for being publicly traded and being able to attract investors. Mr. Brock
will review this information and will be ready for you at the appointed time. To make the most of the appointed time the form must be completely filled out.
Note: Print this out before you click submit, so you have copy on hand during the consultation.
Company Name:
First Name*:
Last Name*:
Address*:
Address 2:
City*:
Country*
USA
Canada
Other
State/Country*:
Zip Code*:
Phone*:
Fax:
Email*:
IMPORTANT - PLEASE SPECIFY: Preferred call-in time: (Pacific Time)
QUESTIONS:
1.
In
which industry do you conduct the majority of your business?
Technology,
Internet or Telecom
Computer
- VARHardware/Software
Professional
Services, Accountants, Legal or Finance
Retail,Consumers,
Food Service, Sports or Entertainment
Manufacturing
- High Tech or Traditional
Oil,
Gas, Energy or Mining
Automotive,
Transportation or Aerospace
Education,
Health Care, Biotech or Social Assistance
Agriculture,
Farming orEnvironmental
Other
2.
What
is your primary product or service?
Please
type answer:
3.
How
long have you been in business?
0
- 6 months
6
months - 1 year
1
- 2 years
2
- 5 years
5
-10 years
over
10 years
4.
How
is your business organized?
Sole
Proprietorship
Corporation
S
Corporation
Partnership
LLC
Other
5.
What
stage of development best describes your company?
Start
Up
Research
and Development Only
Prototype
Completed
Pre-Beta
Trials or Surveys
Beta
Deployment/Testing
Pre-Production
In
Production, but not yet Generating Sales
Generating
Sales, but not Profitable
Generating
Sales and Profitable
6.
What
is your current geographic market?
Local
Statewide
Regional
National
International
7.
What
is the size of your market? (in annual dollar sales)
8.
What
are your last 12 months revenues?
9.
How
much have your sales grown over the last year?
No
Sales Yet
Negative
SalesGrowth
0
- 10%
10
- 20%
20
- 50%
50
- 100%
More
than 100%
10.
What
is your most recent 12 month profit/loss?
11.
What
is your company's current net worth?
12.
What
percentage of your revenues does your
largest client represent?
How
many years of combined experience does your executive
management team have in the industry? (including yourself)
15.
Do
you hold any patents or other significant intellectual
property that gives your company distinct competitive advantage?
yes
no
If "yes" explain:
16.
Does
your business require the use of another company's
patent(s), trademark(s), copyright(s) or rights to generate
a
significant portion of your revenue?
yes
no
If "yes" explain:
17.
How
much financing have you received in the last year?
18.
What
amount of capital are you seeking from a public offering?
19.
How
will you use the funds raised through a public offering?
Please
type answer:
20.
What
is your projected revenue in Year 1 after going public?
21.
What
is your projected revenue in Year 2 after going public?
22.
What
is your projected revenue in Year 3 after going public?
23.
Please
describe in detail what the sources of your revenue are
or will be. Please be as specific as possible.
Please
type answer:
24.
Assuming
you go public, when do you project that you will break even?
Currently Profitable
0
- 6 months
6
months - 1 year
1
- 2 years
2
- 3 years
3 - 4 years
Over 4 years
25.
Are
your clients, customers or consumers potential investors in
your company?
yes
no
26.
Are
your close business contacts or friends potential investors
in your company?
yes
no
27.
Are
you under contract with any source that has rights to stock
in your company?
yes
no
28.
Is
your company involved in any type of lawsuit?
yes
no
29.
Rate
the complexity to the average investor of understanding
your business model and objectives:
Simple,
any adult would understand it.
Moderate,
need general knowledge to understand it.
Hard, need specific knowledge of the industry to understand
it.
Impossible, only a few experts would understand the complexity.
30.
How
long does it take to explain to a potential investor why
they should invest in your company?
Less
than 5 minutes
5
- 10 minutes
10
- 15 minutes
15
- 30 minutes
More
than 30 minutes
31.
In
what state (or province) will your primary office be located?
(i.e. California, etc.)
Please
type answer:
32.
Do
you have a website?
yes
no
33.
Where
did you hear about GoPublicToday.com?
Please
type answer:
34.
Any
additional comments:
35.
Business
Plan Review. If you have a business plan you would like to have
reviewed, please upload up to 5 relevant documents here.
