Request Valuation Proposal Form

Entity Information
Entity Name:
* Type of entity to be valued:
Entity Type Detail:
Entity Type Other:
Common Stock:
Preferred Stock:
Options / Warrants:	Yes No
Partnership Detail:
LLC / LLP Detail:
Nature of Business General description of the entity's business and SIC (Standard Industrial Code as shown on tax return) if appropriate.
Date of Formation:
State of Organization or Incorporation:
Principal Location (City, State):
Facilities:
Revenue:
Assets:
Book Value:
Profitablilty:
Any Pertinent Agreements? Please briefly describe any agreements that are relevant to the appraisal service requested. For example: Shareholder agreement restricting sales of common stock to third parties Partnership agreement requiring 75% vote of limited partners to remove general partners
Financial Statements Available Since:
Nature of Financial Statements Available:
Contingent Liabilities / Nonoperating Assets PPlease briefly describe contingent liabilities and/or nonoperating assets. For example: Summer home in Utah Property leased to third party Boat, planes, etc., not used in the business
Known Deadlines or Desired Timetable If there is a known deadline (e.g., an estate tax filing date), please indicate. FMV Opinions strives to complete every project within 6 weeks of obtaining the necessary information from our clients.

Contact Information
* First Name:
* Last Name:
* Email:
Company:
Title:
Phone:
Relationship to Client:
Other Questions / Comments