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usiness Information Packet

Instructions: The following questions make up the Confidential Business Information (CBI) packet. In order for our firm to fully understand your current business situation so that we may properly address your unique issues, it is imperative that we have certain specific information about you and your business. Please take the time to carefully read and answer each question to the best of your knowledge. You may use the <Tab button> on your computer to move among answer boxes. Any questions that you do not understand or cannot answer can be brought up with the attorney either on the phone or at your initial appointment. We understand this may appear to be a somewhat time-consuming form; however, in providing this key information now, we will know exactly how to approach your business plan and have a more meaningful meeting.

Disclaimer: The following information is completely confidential and private. We do not sell any information you provide us. Also, we will not share this information with any other individual or entity without your prior written consent.

Submitting the CBI: When you have completed the Confidential Business Information online, you have two options for how to proceed:

1. You may click the <Submit button> at the bottom of the page. This will save and send a copy of your CBI to our offices for us to keep on record and review prior to our meeting.

2. You may print out a hard copy of this form and either fax or mail it to our offices for us to keep on record and review prior to our meeting.

Either way, we recommend that you print out and save a copy of the CBI for your own personal records. Thank you again for taking the time to complete this Confidential Business Information packet, and we look forward to meeting with you to discuss your business plan.

Personal Information

Your Information
Full Legal Name
Signature Name
Nickname
Birthdate
Social Security Number
Home Address
City
State
Zip
County
E-Mail
Home Telephone
Cell Phone
Fax
Employer
Business Phone
Business Address
City
State
Zip
Your Partner's Information
Partner's Legal Name
Signature Name
Nickname
Birthdate
Social Security Number
Home Address
City
State
Zip
County
E-Mail
Home Telephone
Cell Phone
Fax
Employer
Business Phone
Business Address
City
State
Zip

Advisors

Name of:		Phone
Attorney:
Accountant:
Financial Advisor:
Life Insurance Agent:
Stock Broker:
Who Referred You:

Business Information

Existing Business
Name of Company:
Type of Business:
Date Formed:
Tax ID Number:
Number of Employees:
Key Employees:
Partners:
Business Address:
City:
State:
Zip:
County:
Telephone Number:
Proposed Business
Proposed Name:
Is name reserved with Secretary of State?:	Yes No
Type of Business:
Date Formed:
Tax ID Number:
Number of Employees:
Key Employees:
Partners:
Business Address:
City:
State:
Zip:
County:
Telephone Number:

Important Business Questions

Business Entity Exit/Transition Strategies

Business entities can and are usually organized to exist in perpetuity. However, the human owners must be prepared to deal with disability, retirement, and death. Therefore, an exit strategy or transition is a critical component of any business.

Business Bank Accounts

Type: Checking Account 'CA', Savings Account 'SA', Certificate of Deposit 'CD' (Indicate type below).

Evidence of Title: Signature card, or the document you signed, to set up the account.

Note: If account is in your name (or in your partner's name) for the benefit of the company, please specify and give that name.

Institution:	Type:	Amt.:	$
Owner:	Acct. #

Institution:	Type:	Amt.:	$
Owner:	Acct. #

Institution:	Type:	Amt.:	$
Owner:	Acct. #

Institution:	Type:	Amt.:	$
Owner:	Acct. #

Institution:	Type:	Amt.:	$
Owner:	Acct. #

Total			$

Real Property Related to Your Business

Type: Land, buildings. If two or more names are on a deed or contract that does not state the type of ownership, enter the property below and please use '?' for owner.

Evidence Of Title: Deed or land contract (Do not use mortgage or tax assessment.)

General Description	Owner	Fair Market Value	Mortgage	Rent
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
Totals		$	$	$

Brokerage and Mutual Fund Accounts (non-qualified accounts)

Type: Money Market "MM", Investment "I", Cash Management "CM", or other account that is in a street name (Indicate type below).

Evidence of Title: The documents you signed to set up the account; account statement.

Note: If account is in your (or in your partner's name) for the benefit of the company, please specify and give that name.

Name of Brokerage Firm or Mutual Fund:	Type:
Owner:	Account Number	Current Value $

Name of Brokerage Firm or Mutual Fund:	Type:
Owner:	Account Number	Current Value $

Name of Brokerage Firm or Mutual Fund:	Type:
Owner:	Account Number	Current Value $

Name of Brokerage Firm or Mutual Fund:	Type:
Owner:	Account Number	Current Value $

Name of Brokerage Firm or Mutual Fund:	Type:
Owner:	Account Number	Current Value $

Total Current Value		$

Stock and bond certificates

Type: Stock in publicly owned corporations which is stock traded on an exchange or over the counter. (Stock owners in family, or nonpublicly traded companies, should be listed under 'Corporate Business Interests'. Stocks held in a street name, or investment account, should be listed under 'Brokerage and Mutual Fund Accounts'.)

Evidence Of Title: Stock certificate.

Company	Owner	Number of Shares	Fair Market Value
			$
			$
			$
			$
			$
Total Fair Market Value			$

Why have you taken physical possession?
Are any shares held in a Dividend Reinvestment Plan (DRIP)?	Yes No

Stock options or Executive Compensation Plans

ISO/NQSO	Company	Number of Shares	Strike Price	Current Stock Price
			$	$
			$	$
			$	$
			$	$
			$	$
Total				$

Deeds, Notes, Partnership and LLC Interests

Type: General/Limited Partnerships and Limited Liability companies. Please state the percentage interest you have in the partnership when you list your interest as a general/limited partner or member.

Evidence Of Title: Partnership/LLC agreement, certificate of partnership, or any documents you signed when purchasing the partnership/LLC interest. Include any buy/sell agreements.

	Percentage Owned
Partnership Name	General Partner	Ltd Partner Member	Owner	Net Value
	%	%		$
	%	%		$
	%	%		$
	%	%		$
	%	%		$
	%	%		$
	%	%		$
	%	%		$
Total				$

Do you have an exit strategy in place for these assets?

Yes No

Corporate and Sole Proprietorship Business Interests

Type: Privately owned (non-publicly traded) stock. (Please indicate if a Buy/Sell Agreement exists and, if stock is owned either JT or TC with another individual or entity, please furnish name and relationship.)

Evidence of Title: Stock certificate, minute book.

Company	No. of Shares	Buy/Sell Agreement	Percentage Ownership	Owner	Net Value
			%		$
			%		$
			%		$
			%		$
			%		$
			%		$
			%		$
			%		$
Total Net Value					$

Are any financial or tax benefits needed?

Yes No

Retirement Accounts Type: Pension 'P', Profit Sharing 'PS', H.R. 10, IRA, SEP, 401(K), Roth (indicate type below)

Evidence of Title: Summary plan description, documents you signed to set up the plan, account statement, beneficiary designation.

Type:	Participant:	% Vested
Company:	Beneficiary:	Value	$

Type:	Participant:	% Vested
Company:	Beneficiary:	Value	$

Type:	Participant:	% Vested
Company:	Beneficiary:	Value	$

Type:	Participant:	% Vested
Company:	Beneficiary:	Value	$

Type:	Participant:	% Vested
Company:	Beneficiary:	Value	$

Type:	Participant:	% Vested
Company:	Beneficiary:	Value	$

Total Value			$

Retirement Plan
Employee Benefits vs. Costs:
(group health/medical plans)
(cafeteria plans)
Ownership Issues:
What are your exit strategies?
What are your personal retirement plans?
Key Employee Issues

Life Insurance Policies and Annuities

Type: Term, whole life, split dollar, group life, annuity (Indicate type of policy below. If a corporation or company owns the policy, or pays the premium on the policy, write 'Corporation'.)

Evidence of Title: The policy itself, including all endorsements and amendments, and the original application you signed.

Company
Policy Number		Type
Owner		Who pays premium
Insured
Primary Beneficiary
Secondary Beneficiary
Face Amount	$	Cash Value	$	Amt. of Loans on Policy	$

Company
Policy Number		Type
Owner		Who pays premium
Insured
Primary Beneficiary
Secondary Beneficiary
Face Amount	$	Cash Value	$	Amt. of Loans on Policy	$

Company
Policy Number		Type
Owner		Who pays premium
Insured
Primary Beneficiary
Secondary Beneficiary
Face Amount	$	Cash Value	$	Amt. of Loans on Policy	$

Company
Policy Number		Type
Owner		Who pays premium
Insured
Primary Beneficiary
Secondary Beneficiary
Face Amount	$	Cash Value	$	Amt. of Loans on Policy	$

Company
Policy Number		Type
Owner		Who pays premium
Insured
Primary Beneficiary
Secondary Beneficiary
Face Amount	$	Cash Value	$	Amt. of Loans on Policy	$

Company
Policy Number		Type
Owner		Who pays premium
Insured
Primary Beneficiary
Secondary Beneficiary
Face Amount	$	Cash Value	$	Amt. of Loans on Policy	$

Summary of Values

Enter totals from prior sections.

Assets	Amount
	Community Property Or Joint Ownership	Separate Ownership (H,W)	Total
Bank Accounts	$	$	$
Real Property Related To Your Business	$	$	$
Brokerage And Mutual Fund Accounts	$	$	$
Stock Certificates	$	$	$
Stock Options	$	$	$
Deeds, Notes, Partnerships and LLC Interests	$	$	$
Corporate and Sole Proprietorship Business Interests	$	$	$
Retirement Accounts	$	$	$
Life Insurance Policies and Annuities	$	$	$
Total Assets	$	$	$
Liabilities
Real Estate Mortgages Payable	$	$	$
Other Loans Payable	$	$	$
Accounts Payable	$	$	$
Contingent Liabilities	$	$	$
Loans Against Life Insurance	$	$	$
Unpaid Taxes	$	$	$
Total Liabilities	$	$	$
Net Corporation (Total Assets Minus Liabilities)	$	$	$

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