MountainWest Capital Network

Utah 100 Application

MountainWest Capital Network
Recognizing Utah's Fastest Growing Companies

2008 Official Application Form
Deadline: Must be submitted by August 4, 2008

Awards will be presented based on revenue growth from 2003 through 2007. To be eligible, the applicant must complete all applicable information below and meet each of the following criteria: (1) be a for-profit Utah-based corporation, limited liability company, or partnership; (2) have a full five year operating history; and (3) have had a minimum of $50,000 in total revenues in fiscal 2003.

Please Apply Regardless of Company's Percent Growth

Company Name: (as you would like it to appear in the program)
Company Website:
Address:
City:
Zip:
Phone:
Fax:
President/CEO:
Official Title:
E-mail:
Contact Person:
Title:
Describe your company:	Describe your company, key personnel, markets, products, and services (50 words or less)
Organization:
Year Founded:
Founded State:
Publicly Held:
Has the company merged, engaged in a joint venture, or been acquired within the last five years?:
Fiscal 2007 Revenues:
Fiscal 2003 Revenues:
Percentage Growth (2007 - 2003)/2003:
Please Type This Security Code: Reload Image

* Note: If 2003 revenue was less than $50,000, please apply for Emerging Elite.

The applicant acknowledges and agrees as follows: The information contained in this Application Form is deemed confidential and will not be used other than for purposes of the 2007 Utah 100 Program. The financial information provided herein is accurate and fairly represents the total revenues of the applicant for the fiscal years indicated. If determined to be a 2006 Utah 100 award recipient, (1) the applicant authorizes the use and publication (including media coverage) of the applicant’s name, logo, address, and description without any compensation, (2) the applicant will not (A) in any manner state or imply that MWCN or its sponsors endorse the applicant or its products or services, or that MWCN or its sponsors and agents have reviewed, audited, read, approved, accepted or endorsed the accuracy or completeness of the applicant’s current or past financial statements or information; or (B) use the names MountainWest Capital Network or Utah 100 or refer to any award by the MWCN in connection with any offer to sell or purchase or any sale or purchase of securities, and (3) the applicant agrees to be bound by the Utah 100 Logo and HyperLink License Agreement, available at www.mwcn.org, as the same may be modified from time to time. The applicant recognizes the non-profit, public service nature of the Utah 100 Program and agrees to release and hold harmless the MountainWest Capital Network, the sponsors of the Utah 100 Program, and their respective officers, directors, employees, and agents from any liability associated with or arising out of the Utah 100 Program.