PublicShellCompany.Com - Request Information

Merger Process • Shells & Reverse Merger • Structuring the Shell Transaction • Foreign Companies
NASDAQ BBX Stock Exchange • Stock Exchange Links • Request Info. • Contacting Us • Disclaimer

Request for Information on Reverse Mergers

If you are considering going public through a reverse merger with a clean SEC reporting public shell, please take time to fill out our simple form and we will contact you to discuss ways we can help you achieve your goals of taking your private company public.

Your Full Name:

Address:

City, State, Zip Code:

Country, if not USA:

Company Name:

State of Incorporation:

Type of company:

Your position:

Daytime Phone (including area code):

Fax number (including area code):

E-Mail Address:

Web Site URL:

Do you have a business plan?: YES; NO

Common shares issued & outstanding:

Preferred shares issued & outstanding:

Number of Shareholders currently (approximately):

Approximate annual sales:

Approximate annual net earnings:

Approximate total Assets:

Approximate total net worth:

Date of last audited financials:

Why do you want to go public?
(Enter as much information as you wish.)