Information We Need PreQual

Company to be Valued:

*Required

The name of the company that is to be valued*

Your Contact Info

First Name*

Last Name*

Email address*

Phone Number*

Company

Country*

Address*

City*

ZIP Code*

Ownership percentage to be valued?

Based on ownership percentages of the company:Total number of shares

Effective date of the valuation

1) Most recent month-end, quarter-end or year-end date of last financials or
2) Date of an event (e.g. employee termination, date of separate, date of gift. etc.)

In what State, is the primary location of the business?*

In what industry is the business most closely affiliated?*

Preferred Lenders

(Optional: please identify any lenders you would like to receive Part A. BizWorth will send invites to each lender you request and include with BizWorth’s preferred lender network.)

Lender Information

First Name

Last Name

Company

Phone Number

Email address

+ Add additional lenders

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Company to be Valued:

Your Contact Info

Ownership percentage to be valued?

Effective date of the valuation

In what State, is the primary location of the business?*

In what industry is the business most closely affiliated?*

Preferred Lenders

Lender Information

Effective Date of Valuation

How did you hear about us?

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Your order has been received

Your Purchase was Successful!

But, we still need more info

Company to be Valued:

Your Contact Info

Ownership percentage to be valued?

Effective date of the valuation

In what State, is the primary location of the business?*

In what industry is the business most closely affiliated?*

Preferred Lenders

Lender Information

Effective Date of Valuation

How did you hear about us?

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