2013 Rochester Top 100 Nomination Form

1. Nominated Company: Please enter the name of your company
2. Address: Please enter your company’s street address
3. City, State, Zip:  Please enter your company’s city, state, and zipcode
4. Telephone: (include area code) Please enter your company’s phone number
5. Year Founded: Please enter the year your company was founded
6. Website:  Please enter the web address of your company’s website
7. Number of Employees - Locally in the greater Rochester area (9 county region) Please enter the number of employees in the Rochester area
8. Number of Employees - Total # of all employees at all locations Please enter the total overall number of employees outside the greater Rochester area

9. Industry - select at least one option

   Construction	e-Commerce	Financial Services	Manufacturing
   Retail	Service	Technology	Wholesale / Distribution

   Please select at least one industry

10. Indicate if considered (optional)

    Minority-owned

    Woman-owned

11. Highest Ranking Company Executive Name:  Please enter the name of your highest ranking executive
12. Highest Ranking Company Executive Title:  Please enter the title of your highest ranking company title
13. Highest Ranking Company Executive eMail:  Please enter the name of your highest ranking company email
14. Brief Business Description: Please describe your company

Company contact to obtain marketing and recognition materials.

Please enter a company representative name here only:
1. Company Contact Name / Title: Please enter your contact for company verification
2. Company Contact Telephone (include area code): Please enter your company’s contact phone number for company verification
3. Company Contact Email: Please enter your company’s contact email address for company verification

• Round all revenues to the nearest thousand. Do not enter commas.
• If available when submitting nomination form, please include required statements of income or first pages of tax returns for each of the company’s three most recent fiscal years as proof of revenues.
• All revenue figures will be held in confidence by KPMG.

1. Most Recent Fiscal Year: Please enter the revenue for the most recent fiscal year in numbers only
2. 1st prior Fiscal Year: Please enter the revenue for the first prior fiscal year in numbers only
3. 2nd prior Fiscal Year: Please enter the revenue for the second prior fiscal year in numbers only

1. for Most Recent Fiscal Year (Optional):
2. for 1st Prior Fiscal Year (Optional):
3. for 2nd Prior Fiscal Year (Optional):

If the nominated company’s proofs of revenue are unavailable at the time of submission, you must enter a financial contact name below so that KPMG is able to obtain the required information during their verification process.

Please enter a financial representative name here only:
1. Financial Contact Name / Title: Please enter your company’s contact for revenue verification
2. Financial Contact Telephone (include area code): Please enter your company’s contact phone number for revenue verification
3. Financial Contact Email: Please enter your company’s contact email address for revenue verification

1. Nominator Name / Title: Please enter your name
2. Nominator Contact Telephone (include area code): Please enter your phone number
3. Nominator Contact Email: Please enter your email address