In order that we may evaluate your company and conduct the due diligence required in order to properly evaluate various investment banking options and strategies by JSC please complete and return to us the following Due Diligence Questionnaire.

    Company Name:

               Address:

                      City:

                     State:

              Zip Code:

            Telephone:

                       Fax:

                    Email: *

                      URL:

Desired Transaction: * { Please select item of interest } Private placement Debt Financing Secondary Offering Venture Capital Merger Acquisition of another business Initial Public Offering Investment Banking Advice Purchase or merger with Public Shell Sale of Company

What do you value your company at today and how did you come to that conclusion?

*

Please supply the following information when requested after initial contact with JSC