Utah 100 Application

MOUNTAINWEST CAPITAL NETWORK – Recognizing Utah’s Fastest Growing Companies

Utah 100 Program

Deadline: Must be submitted online by June 30, 2017

Awards will be presented based on revenue growth from 2012 through 2016. 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 five full years of operating history; and
  3. have had a minimum of $50,000 in total revenues in fiscal 2012.

Note: If the Company had less than $50,000 in revenue in 2012, please use the Emerging Elite application.
To view Logo and Hyperlink Agreement Click Here

PLEASE APPLY REGARDLESS OF COMPANY’S PERCENT GROWTH

CEO Name*
CEO Email*
CEO Executive Admin Name*
CEO Executive Admin Email*
Company Name*
Website*
Business Address*
City*
State*
Zip Code*
Phone*
President, CEO or highest Executive Officer*
Official Title*
CFO Name*
CFO Email*
Marketing or Contact Person Name*
Marketing or Contact Person Company (if different from company applying)*
Marketing or Contact Person Email*
Previous Winner?*
Number of Years Previously Recognized?*
How Did You Hear About the Utah 100?
Describe your company: (50 words or less)*
Type of Entity*
Year company founded*
State of Incorporation
Is the company publicly held?*
Has the company merged, engaged in a joint venture, or been acquired within the last five years?*
Fiscal 2016 Total Revenues: (in dollars, no cents, no commas)*
Fiscal 2012 Total Revenues: (in dollars, no cents, no commas)*
Percentage Growth from 2012 to 2016: (2016 Revenue - 2012 Revenue)/2012 Revenue*
Contact Person for Financial Information
Would you be willing to keynote a future MWCN Business Forum?
By clicking submit, the applicant agrees to the following:
The information contained in this application Form is deemed confidential and will not be used other than for purposes of the 2016 Utah 100 Program. The financial information provided herein is accurate and fairly represents the total revenues of the applicant for the fiscal years indicated. The applicant agrees to provide the Utah 100 selection committee with support for the financial information provided. If determined to be a 2016 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.