Issuer Request Form

Please provide the information and contacts requested below so that you can be notified when EJP score and reports on your company are available for review before publishing. Please note that only company employees can view these draft reports on this system, no consultants on outside vendors please.

NOTE: An asterisk (*) denotes required field. The form can only be successfully submitted once these fields are filled out properly.

Issuer name*

Stock symbol*

Stock exchange*

CIK

CUSIPs

Primary Contact Information

Name*

Title*

Email*

Phone

Address

City

State

Postal Code

Country*

Second Contact Information

Name

Title

Phone

Address

City

State

Postal Code

Country

Issuer Solicitor Information

Name

Phone

Address

City

State

Postal Code

Country

Issuer Compensation Consultant Information

Name

Phone

Address

City

State

Postal Code

Country

Issuer Legal Representation Information

Name

Phone

Address

City

State

Postal Code

Country

Please confirm that you are human*

NOTE: An asterisk (*) denotes required field. The form can only be successfully submitted once these fields are filled out properly.

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