Shareholder Decision Survey Form
Shareholder Decision Survey Form for collecting shareholder input on a company decision and related preferences.
Respondent Information
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Company or Organization Name
Shareholder Context
Shareholder status
*
Individual shareholder
Institutional shareholder
Board representative
Executive representative
Other stakeholder
Number of shares held
*
You are voting
*
For myself
On behalf of another party
Decision Survey
Decision Being Evaluated
*
Approve
Reject
Request Revisions
Abstain
Undecided
Agreement with Proposed Decision
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
Priority Factors Influencing Your Decision
Financial Impact
Governance
Risk
Growth Potential
Timeline
Transparency
Other
Concerns or Comments
Submit
Should be Empty: