Acquira Owner Questionnaire

BUSINESS OWNER QUESTIONNAIRE

Contact Name*
Company Name*
DBA (If Applicable)
Confidential Mailing Address*
Mobile Phone #*
Confidential Phone #
Primary Email*
Secondary Email
Website
Spouse Name
Special Instructions
Best Time to Call*

What does your company specialize in providing?*
Type of Business
If Other, please specify
What year was your business established?
Did you start business or acquire it?
Type of Business Structure
If Other, please specify
Area of Operation

Street Address

Street Address Line 2

Hours of Operation

Rows	OPEN	CLOSE
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays

How long would you remain after the sale of the business?
MONTHS ONLY
Why are you selling?

List of Shareholders and Duties

Rows	First Name	Last Name	% of Ownership	Title
Shareholder 1
Shareholder 2
Shareholder 3
Shareholder 4
Shareholder 5

Business Serves the Following Markets (example: commercial, industrial, residential, medical, defense, aerospace, oil & gas, food, local community, small, medium, large businesses, etc.)

Rows	Industry	% of Market
Market 1
Market 2
Market 3
Market 4

Top Three Primary Certifications & Licenses

Rows	Certification
Certification 1
Certification 2
Certification 3

Top Five Products or Services

Rows	Product/Service Name	% of Business
Product/Service 1
Product/Service 2
Product/Service 3
Product/Service 4
Product/Service 5

Accounting Status
What is your fiscal year?
Estimate FMV of the business's assets WITHOUT Real Estate
Estimate the Company's Gross Revenue for the current fiscal year
When you send an invoice to a customer, when do you expect to receive payment?
UP TO HOW MANY DAYS ONLY

Who is your Company's Healthcare Provider?
Are the employees Union or Non-Union?
How many Total Employees?
How many Hourly Employees?
How many employees receive a Salary?
What is Company Payroll timeline?

Payroll Range

Rows	From $	To $
Hourly Rate Range
Salary Rate Range

Who are the Top 4 Key Employees?

Rows	First Name	Last Name	Title & Position	Duties
Key Person 1
Key Person 2
Key Person 3
Key Person 4

Describe the media you use to promote the business (Print Media, TV, Radio, Web Ads, Social Media, Trade Show, Referral, etc.)

Do you own the building(s) and land?
If you own the Building & Land, do you want to sell or lease it back to the buyer?
What is the monthly lease rate the Company pays each month for the facility?
If you lease, what year does the lease Expire?
What is the number of buildings the business occupies?
What is the total Square Footage of the buildings?
What is the total Square Footage of the office space?
What is the total Square Footage of the production or warehouse area?
What is the zoning of the facility?

Are the accounting functions performed by an outside CPA Firm or In-House?
CPA Firm Name
CPA Firm Phone Number
Please enter a valid phone number.
Do any family members work in the business?
How many personal vehicles/recreational vehicles are in the business?
Paid Time OffVacation Pay
Does the Company offer retirement benefits or a 401K plan?
What is the Company's Warranty Policy? If Applicable
Were there any significant one-time expenses incurred in the past 12 Months?
PROVIDE TOTAL DOLLAR AMOUNT

I understand that the Company Profile is not intended to sell my business but reveal key selling points to Acquira without revealing proprietary information. I have reviewed this material and attest that the information provided herein to be accurate and complete to the best of my knowledge. I understand that all information will be kept confidential and will not be made available to anyone outside of Acquira without my written permission.*

I AGREE
Owner's Signature

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Date

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BUSINESS OWNER QUESTIONNAIRE