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Step 1 of 4

General Information

Name of Parent Company*
Address*
Has the Company been in business longer then three (3) years?*
Is the Company public-held or a public reporting company under the Securities Exchange Act of 1934?*
Does the Parent Company own more than three (3) subsidiaries? If yes, please provide details in the box below.*
Has the Company in the past 18 months been involved with any actual, negotiated or attempted merger, acquisition or divestment? If yes, please use the box below to provide details.*
Does the Company contemplate transacting any mergers or acquisitions in the next 12 months where such merger or acquisition would involve more the 50% of the total assets of the Company? If yes, please use the box below to provide more details.*