BUSINESS IDENTIFICATION

  1. Business/Corporate Name: ______
  1. Business Address: ______

City, State ______

  1. Doing Business as:______
  1. Principal Business Activity: ______
  1. Business Telephone Number: ______
  1. Business start date: ______
  1. Organizational form (Corp., S.P., Prtnshp): ______
  1. State Incorporated: ______

VALUATION DETAIL

  1. Purpose of Valuation: ______
  1. Date of Valuation: ______
  1. Asking Price for the Business: ______
  1. Common Shares Outstanding: $______Divd. Per Share $______

Pref. Shares Outstanding: $______Divd. Per Share $______

  1. Number of Shares Valued:

Common Stock: ______Preferred Stock: ______

If Partnership, % of business valued: ______%

  1. Any Contractual, creditor or other restrictions on a sale of

the business? ______

  1. Any options outstanding? ______How Many?______
  1. Is the appraised interest a majority stockholder? ______
  1. If no, does any majority interest, (50%+), or control group exist? ______

NATURE OF BUSINESS

  1. If Known, what is your business’ primary SIC Code: ______
  1. Number of Employees: ______
  1. Describe the nature and history of the business, its primary

market(s), its estimated share of such market(s), and its

principal competitor(s).

  1. Is the customer base Local, Regional or National? ______
  2. What are the normal business hours? ______
  3. What is the forecast for the business’ sales growth over the next 3, 5, or 10 years?

Growth %Growth %

Year 1 ______%Year 6 ______%

Year 2 ______%Year 7 ______%

Year 3 ______%Year 8 ______%

Year 4 ______%Year 9 ______%

Year 5 ______%Year 10 ______%

  1. Is sales volume inflation sensitive? ______
  2. Enter monthly sales volume for the last 12 months:

January ______July ______

February ______August ______

March ______September ______

April ______October ______

May ______November ______

June ______December ______

  1. If the following information is not listed separately in the historical income statement, please

do so here. Enter up to five years of historical data. The oldest year should be input under the

FYE1 column.

FYE1 FYE2 FYE3 FYE4 FYE5

Officer Salary ______

Depreciation ______

Interest Exp. ______

Non-Oper. Inc. ______

Non-Oper. Exp(1)______

Income Tax ______

Dividends ______

(1)Nonbusiness related transactions (e.g. gain on sale of assets, pension plan termination, et.) that

are unusual or not part of the operating income and expense for this business.

  1. Enter specific adjustments to the income statement accounts for items that are included in

the income tax return, but that are tax-motivated or would not be applicable when

the proposed sale/purchase is completed.

FYE1FYE2FYE3FYE4FYE5

Accrual Addback

(for cash stmts only) ______

REVENUE DEDUCTIONS:

1. ______

2. ______

3. ______

4. Non-Oper. Inc______

EXPENSE ADDBACKS:

Amortization______

Contributions______

Depreciations ______

Life Insurance______

Officer Salary ______

Rent Expense______

Interest Expense______

COGS______

______

______

______

Payroll Taxes______

Non-Oper. Expense ______

  1. Enter a number from 1 to 5 for each of the following factors, with 1 representing a strong

performance by the company and 5 representing a weak performance.

A. Pre-Tax ROE______

B. Profitability Percentage______

C. Pre-Tax ROA______

D. Current Ratio______

E. Industry Stability/Potential______

F. Earnings Diversity/Stability______

G. Product/Service Quality______

H. Location/Market Position______

I. Competitiveness/Management______

J. Suppliers/Regulations______

EMPLOYEE STRUCTURE

  1. Please list the number and breakdown of employees (including Owners).

# of Staff$ Avg. SalaryYr’s in Position

  1. Management______
  1. Sales______
  1. Production______
  1. Clerical______
  1. Other______

Employee Benefits: ______

Employees Covered: ______

  1. Management & Supervisory Background:

#1#2#3

Name______

Title______

Duties______

Background______

Age______

Salary______

Ownership______%______%______%

Are people being trained to take over management? ______

PHYSICAL PREMISES

  1. How long has the business occupied the premises: ______

2. Outgrown premises? (Yes/No) ______% in use ______%

  1. Own or Lease premises? ______Sq. Footage ______
  1. If own, please attach legal description and estimate value.
  1. If lease, What is monthly rent?$ ______

What is market rent for similar property today? ______

How many months remain on current lease term? ______

Is there an Inflation Price Index clause: (Yes/No) ______

6. Restrictions on re-assignment of the lease? ______

  1. If retail, is parking for the general public (Yes/No) ______

or your own parking lot (Yes/No) ______

How many spaces? ______