Express IPO Capital Questionnaire

Express IPO Capital Corporate Eligibility Questionnaire

First Name:
Last Name:
Title:
Company Name:
Address 1:
Address 2:
City:
Country:
State/Province:
Zip Code/Postal Code:
Phone:
Fax:
Email:
Web Site URL:

Please complete the following questionnaire so that we have a brief overview of your company.

Business type (check all that apply)

Sole Proprietorship

Corporation

S Corporation

Partnership

LLC

Foreign Public Company (any company located outside the United States)

Other

Primary product or service

How Long in business

0 – 6 months

6 months – 1 year

1 – 2 years

2 – 5 years

Over 5 years

Number of Employees

1 - 5

6 – 10

11 – 20

Over 20

Company's Annual Revenue

Nil

$10,000 - $25,000

$25,001 - $50,000

$50,001 - $75,000

$75,001 - $100,000

$100,001 - $500,000

$500,001 - $1,000,000

Over $1,000,000

Do you have current financial statements

Yes No

Do you or your company hold any patents or intellectual property?

Yes No

Where do you market your product or service?

United States

International

Countries

How many shareholders do you have?

Do you have a business plan

Yes No

Is your company involved in any type of lawsuit

Yes No

Where did you hear about Express IPO?

Send your business plan

Consulting services for companies who would like to Go Public - providing a thorough review of the company's organizational structure, financial history, their strategies for growth and expansion and whether they would qualify for being publicly traded and which process to use.

Assist companies to go public on the Frankfurt Exchange - Express IPO will assist in the listing of your company on one of the best alternative markets for a small company today - The Frankfurt Stock Exchange.

Assist companies to go public on the Pink Sheets - Express IPO will assist in the preparation of all the documentation and disclosure required for a listing on the Pink Sheets.

Assist companies to go public on the OTC Bulletin Board - Express IPO will assist in the process required for trading on the Over the Counter Bulletin Board (OTCBB) market.

Shell company acquistions, SB-2 Registration and Reverse Merger consulting - Express IPO has access to shell companies for Pink Sheets and OTCBB markets and consults on Reverse Mergers. In addition, Express IPO will provide assistance in preparation of SB-2 registration statements.