ESOP Builders Inc. - Feasibility Questionnaire

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Feasibility Questionnaire

If you are interested in getting some feedback from us with regard to the feasibility of implementing an ESOP, complete the following questionnaire.

The questions which allow for multiple answers are marked with a "**". To select a variety of answers from the list, hold down your Control Key [Ctrl] and use your mouse to pick the answers from the list. The fields marked ** must be completed.

ALL INFORMATION IS STRICTLY CONFIDENTIAL AND WILL NOT BE USED FOR ANY OTHER PURPOSE.

1.	Are you a private company?	Yes No
2.	How many employees in your company?
3.	How many employees do you wish to include in an ESOP?
4.	What is the approximate annual revenue?
5.	What is the average annual growth rate in number of employees in percent?	%
6.	What industry are you in?
7.	How many shareholders currently?
8.	Are these principle shareholders willing to reduce their ownership?	Yes No
9.	Have the employees been promised some kind of employee ownership in the past?	Yes No
10.**	What are the main objectives of the current owner(s) in providing an ESOP?	Attracting Employees Retain Employees Improve productivity Provide incentive plan Leave the business Grow commitment and company Other response
	If you selected "Other response", please explain.
11.	Do you currently distribute corporate financial information to employees?	Yes No
12.	Do you have difficulty attracting or retaining key individuals to your company?	Yes No
13.	Do you currently have an incentive plan in place?	Yes No
14.**	What is your exit strategy (ie. Sale, IPO, Merger etc.)?	IPO Merger Sale to management/employee Sale to 3rd party Other
	If you selected "Other", please explain
15.	Do you have foreign subsidiaries?	Yes No
16.	Additional information which may help us understand your company
	Your Full Name	**
	Title / Position
	Name of Company
	Address
	City
	State/Province
	Zip/Postal Code
	Country
	E-mail where we can write to you.	**
	Address of your Web Site (if applicable)
	Telephone Number
	Please tell us how you found out about our Web Site. Select as many as you like.**	Internet Search Engine Newsletter Recommended by a Friend Magazine Newspaper Other
	If you used a search engine, can you tell us the phrase you used to locate our site? (e.g. ESOP)
	Please click on the submit button to send your form by e-mail to ESOP BUILDERS INC.

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