REVENUE VERIFICATION FORM

Our client has applied for membership at the ENTREPRENEURS’ ORGANIZATION (EO). We have noted below the gross revenue, entity type and percentage ownership for the most recent fiscal year end.

This information is prepared for the use of ENTREPRENEURS’ ORGANIZATION to assess our client's eligibility to be a member of the organization.

This information was neither audited nor verified by me, and I make no representation, nor do I provide any assurance regarding the accuracy of this information for EO’s decision making process.

This information is not appropriate for any purpose other than for assessing the qualifications for membership. We, the undersigned, understand that the information provided below will be kept strictly confidential.

Client/Business Owners First Name
Client/Business Owners Last Name
Client/Business Owner's Organisation
Client / Business Owners Email
$
Gross Revenue
Fiscal Year End Date
Acountants Name
Accountant Firm Name
Accountant email
Accountant Address
Accountant Phone Number
Business Structure*
Business Structure
Client Ownership %
Clear
Accountant Signature