2012 Technology Fast50/500 Nomination Form

To submit your company's nomination online, please complate the from below and attach the required financial documentation. Your nomination form will not be complete without providing this information.

Deadline to submit nominations: June 15, 2012.
Note: Before you fill out the form please make sure you read Entry Criteria

Company Headquarters Information :
Company Name :
(Please provide us your company name as you would like to it to appear in public and award materials.)
Office Adress:
City :
Zip/Postal Code :
Phone :
(e.g "555-123 45 67") 		 
Fax
(e.g "555-123 45 67")
Web site :
Year Established :
(By notifying us of your Web site, you agree to allow Deloitte to link to that Web site if you become a Fast50 or Fast500 winner.)
Past Fast50/500 Winner?:  
       If yes, please state the year(s):
       *all that apply





Chief Executive Officer :
Salutation   :
First Name :
Last Name :
Exact Title   :
(Please provide us the CEO Name and Exact Title as you would like it to appear in public and award materials.)
CEO Email Address :
(Please provide CEO’s own email address, different from assistant email address.)
Assistant  Email  Address :

Operating Revenues :
Private companies must submit tax returns or audited financial statements to complete their eligibility. Reports for the years 2007 and 2011 are required to be submitted (see below, you may attach the reports) for Technology Fast50/500 nomination.
  • Year
  • 2007
  • 2008
  • 2009
  • 2010
  • 2011
  • Exchange rate
  • 1.77818 TL
  • 1.89577 TL
  • 2.15052TL
  • 1.9887 TL
  • 2.3244 TL
FYE 2007 Revenues (€) : 
FYE 2008 Revenues (€) :
FYE 2009 Revenues (€) :
FYE 2010 Revenues (€) :
FYE 2011 Revenues (€) :
Amount of expenditures for
FYE 11 R&D (Ar-Ge) (€) :
Does your company own proprietary technology that contributes to a significant portion of your operating revenues? :
Month Fiscal Year Ends:

Industry Type:
(Please choose the industry type that best describes your business.)
How did you hear about the programme











If other please specify

Second Contact Person (PR or Marketing etc.)
Salutation
First Name :
Last Name :
Title :
Company :
Street :
City :
Zip/Postal Code :
Phone :
(e.g. "555-123 45 67")      		 
Email Address :
* Nomination confirmation mail will be sent to this address.
 


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