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Find out about Seminars First!

"Does My Company Qualify?"

Can Your Company Offer Stock to the Public Using the Small Business Forms?

Find Out in as little as 30 Minutes.

Go Public Open Line is a No-Cost, fast-moving 30 minute consultation during which Stephen Brock will help you determine whether your company qualifies for using the Small Business Issuer Forms adopted by the SEC.  This consultation normally costs $525.00.  Appointments are granted on a first-come, first-served basis.

The next open line day is scheduled for: Friday, July 25

Begin by filling out this form. What follows is a series of questions to determine your potential for engaging in a successful public offering.  Mr. Brock will review this information and will be ready for you at the appointed time.  To make the most of the appointed time the form must be completely filled out.

IMPORTANT: PLEASE READ
For the no-cost consultation, companies must meet either one of the following two conditions:

· $500,000 Historical Revenue; and
· Projected Revenues of $1 Million; and
· Be cash flow positive.

OR
$2 Million Revenue (w /no operating cash flow requirement)




OR
You may also fill out this Corporate Data Profile to learn about our services that will help you prepare to enter the Capital Markets and prepare Business Plans and PPT presentations for Angel Investors, Hedge Funds, Venture Capital firms etc, as well as developing accounting systems and business development programs. This consultation will be a no cost consultation for companies who have an interest in learning about our services to have us operate as a part time management firm to the company without the high cost of payroll for employe



"By checking this box, I acknowledge that my Company meets the stated requirements."
Company Name:
First Name*:
Last Name*:
Address*:
Address 2:
City*:
Country* USA     Canada     Other
State/Country*: 
Zip Code*:
Phone*:
Fax:
Email*:
IMPORTANT - PLEASE SPECIFY: Preferred call-in time: (Pacific Time)


QUESTIONS:
1.    In which industry do you conduct the majority of your business?
Technology, Internet or Telecom
 Computer - VARHardware/Software
 Professional Services, Accountants, Legal or Finance
 Retail,Consumers, Food Service, Sports or Entertainment
 Manufacturing - High Tech or Traditional
 Oil, Gas, Energy or Mining
 Automotive, Transportation or Aerospace
 Education, Health Care, Biotech or Social Assistance
 Agriculture, Farming or Environmental
 Other


2.    What is your primary product or service?
Please type answer:


3.    How long have you been in business?
0 - 6 months
 6 months - 1 year
 1 - 2 years
 2 - 5 years
 5 -10 years
 over 10 years


4.    How is your business organized?
Sole Proprietorship
 Corporation
 S Corporation
 Partnership
 LLC
 Other


5.    What stage of development best describes your company?
Start Up
 Research and Development Only
 Prototype Completed
 Pre-Beta Trials or Surveys
 Beta Deployment/Testing
 Pre-Production
 In Production, but not yet Generating Sales
 Generating Sales, but not Profitable
 Generating Sales and Profitable


6.    What is your current geographic market?
Local
 Statewide
 Regional
 National
 International


7.    What is the size of your market? (in annual dollar sales)


8.    What is the estimated growth for your product/service? (in annual dollar sales)


9.    What are your expected/forecasted sales for:
Next Year:
Year after next:


10.    What are gross margins for your Company?


11.    What is the estimated target market/industry gross margins for product/service?


12.    Choose the option that best describes the pricing power for you product/service:
High
Medium
Low 


13.    Are you cash flow, operating cash flow and/or operating income positive?
At least one of the above
None of the above

If none of the above, when do you estimate or forecast when your company will be positive for cash flow, operating cash flow and operating income?


14.    What is the current book value for your business?


15.    What is the current working capital for your business?


16.    What is your debt position?
Current:
Long-term:


17.    Do you have an in-house controller?
Yes No


18.    Does that person hold an accounting degree or a CPA designation?
Yes No


19.    What internal accounting system is used?


20.    Is the accounting bookkeeping period being closed monthly or quarterly?
Monthly Quarterly


21.    Do you intend to change audit firms or accountants in the next fiscal year period?
Yes No


22.    How did you discover GoPublicToday.com or hear about our services?


23.    How have you been funded in the past?
Debt   Equity   Other

Please Explain:


24.    What form of funding/financing do you expect in the future?
Debt   Equity   Other

Please Explain:


25.    What type of barriers to entry exist in your marketplace?


26.    Explain your product/service differentiation (price, quality or unique service/product):


27.    How many executive manager level officers at the Company?


28.    What are your last 12 months revenues?
(Revenues less than 500k but still want a consultation?)


29.    How much have your sales grown over the last year?
No Sales Yet
 Negative SalesGrowth
 0 - 10%
 10 - 20%
 20 - 50%
 50 - 100%
 More than 100%


30.    What is your most recent 12 month profit/loss?


31.    What is your company's current net worth?


32.    What percentage of your revenues does your
largest client represent?
1 - 10%
 10 - 20%
 20 - 35%
 35 - 50%
 50 - 75%
 75 - 100%
 No Sales Yet


33.    How many employees do you have?


34.    How many years of combined experience does your executive
management team have in the industry? (including yourself)


35.    Do you hold any patents or other significant intellectual
property that gives your company distinct competitive advantage?
yes
 no
If "yes" explain:
36.    Does your business require the use of another company's
patent(s), trademark(s), copyright(s) or rights to generate a
significant portion of your revenue?
yes
 no
If "yes" explain:


37.    How much financing have you received in the last year?


38.    What amount of capital are you seeking from a public offering?


39.    How will you use the funds raised through a public offering?
Please type answer:


40.    What is your projected revenue in Year 1 after going public?


41.    What is your projected revenue in Year 2 after going public?


42.    What is your projected revenue in Year 3 after going public?


43.    Please describe in detail what the sources of your revenue are
or will be. Please be as specific as possible.
Please type answer:


44.    Assuming you go public, when do you project that you will break even?
Currently Profitable
 0 - 6 months
 6 months - 1 year
 1 - 2 years
 2 - 3 years
3 - 4 years
Over 4 years


45.    Are your clients, customers or consumers potential investors in your company?
yes
 no


46.    Are your close business contacts or friends potential investors in your company?
yes
 no


47.    Are you under contract with any source that has rights to stock
in your company?
yes
 no


48.    Is your company involved in any type of lawsuit?
yes
 no


49.    Rate the complexity to the average investor of understanding
your business model and objectives:
Simple, any adult would understand it.
 Moderate, need general knowledge to understand it.
Hard, need specific knowledge of the industry to understand it.
Impossible, only a few experts would understand the complexity.


50.    How long does it take to explain to a potential investor why
they should invest in your company?
Less than 5 minutes
 5 - 10 minutes
 10 - 15 minutes
 15 - 30 minutes
 More than 30 minutes


51.    In what state (or province) will your primary office be located?
(i.e. California, etc.)
Please type answer:


52.    Do you have a website?
yes
 no
If "yes":


53.   
 Any additional comments:


54.    Business Plan Review. If you have a business plan you would like to have reviewed, please upload up to 5 relevant documents here.
 
55.    Do you prefer to trade on
OTC BB Pink Sheets AMEX NASDAQ SC


Note:  Print this out before you click submit, so you have copy on hand during the consultation. 


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