Business Valuation Questionnaire

We can prepare a rough valuation using only the documents listed below. To generate a more accurate valuation, please provide information in response to any or all of the questions below, even if such answers are estimates.

Tax returns for the past 2 or 3 years:
• Form 1120s is used for an S corporation or an LLC electing to be taxed as an S corporation.
• Form 1120 is used for a C corporation or an LLC electing to be taxed as a C corporation.
• Form 1065 is used for a partnership or an LLC electing to be taxed as a partnership.
• Form 1040 (Schedule C) is used for a sole proprietorship or a single member LLC taxed as a sole proprietorship.
If Form 1040 (Schedule C) is used, balance sheets for the past 2 or 3 years are helpful.

Full Name

Preferred Contact Method


What is the primary service provided and/or product sold by the company? Is there any other way to better describe what the business does or sells?

When did the business start/incorporate?

What is the rough number of current employees?

Did the business have any one-time/non-operating expenses/losses or revenues/gains in the last 3 years? If so, which types, amounts and years?

Did the business have any contingent liabilities in the last 3 years, and if so, which types, amounts and years, and are those potential liabilities still outstanding?

Including any officer compensation listed on the tax returns and any balance sheets, what is/was the value of the total compensation to owners (other than company profits), year by year, including all types of benefits, if any (e.g., health insurance, retirement insurance, life insurance,company car, etc.)?

If available for the current tax year and/or next tax year, what is/are the projected: (i) revenue; (ii) pre-tax earnings; (iii) officer compensation (including the categories of income mentioned in No. 6 above); (iv) interest expense; (v) depreciation, depletion and amortization; (vi) cash; (vii) accounts receivable; (viii) inventory; (ix) other current assets; (x) fixed assets; (xi) intangible assets; (xii) accounts payable; (xiii) other short term liabilities; (xiv) bank loans; (xv) other long term liabilities; (xvi) contingent liabilities; (xvii) one-time/non-operating expenses/losses; and (xviii) one-time/nonoperating revenues/gains?

On a scale of “1” to “5” with “1” being “remain the same” and “5” being “plummet” what would happen to revenue if an owner(s) suddenly exited the business? Would the impact be greater depending on whether a certain owner exited?

What percent of revenue comes from the top 3 customers?

What percent of revenue is recurring?

If the business rents any physical location(s), is rent paid to an affiliated third party? If so, what is the rent payable and what is the fair market value of rent that could be charged to someone else?

If the business owns any real property or buildings, what is the current fair market value and what is the current mortgage amount, if any, for each piece of property or building?

Please upload any files that may be relevant to the questions above.

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1840 5th St. Springfield, OR 97477  |  (O) 541-583-0093  |

Securities offered through D.H. Hill Securities, LLLP, Member FINRA/SIPC.  D.H. Hill Securities, LLLP, Todd Mann Financial Services, and Belpointe Asset Management, LLC are not affiliated entities.


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