Seller Application Form

Financial Information

Actual
2014 Estimate
2015
Revenue
Revenue Actual*

Revenue Estimate*

Gross Profit
Gross Profit Actual*

Gross Profit Estimate*

EBITDA (*)
EBITDA Actual*

EBITDA Estimate*
(*) for EBITDA, please show net income before interest expense, interest income, depreciation and income taxes.
Company Overview
Year Founded
year founded*
Organization
organization type*
- S-Corp
- C-Corp
- Other
Number of Owners
# of owners*
Number of Employees
# of employees*
Headquarters (City & State)
city or state*
Industry (briefly describe industry, or indicate SIC code)
industry*
Website Link
website
Contact Information
Your Name
Name*
First Last
Phone Number
Phone*
Email Address
Email*

Financial Information