What level of Annual Gross Sales/Receipts do you feel you need:$ to stay in business.$ to be satisfied in business.$ to be extremely satisfied in business.
ASSETS (In Even Dollars)$* Cash on hand and in Banks U.S. Government Securities Listed Securities Unlisted Securities Other Equity Interests Accounts & Notes Receivable Market Value of Real Estate Owned Cash Value Life Insurance Other Assets TOTAL ASSETS (A)
LIABILITIES (Balances In Even Dollars)$ Notes Payable: This Bank$ Notes Payable: Other Institutions$ Notes Payable: Relatives$ Notes Payable: Others$ Accounts and Bills Due$ Unpaid Taxes$ Real Estate Mortgages Payable$ Land Contracts Payable$ Life Insurance Loans$ Other Liabilities$ TOTAL LIABILITIES (B)
Net Worth (Balances In Even Dollars)$ Total Assets (A)$ Total Liabilities (B)$ TOTAL ASSETS (A) MINUS TOTAL LIABILITIES (B) = TOTAL NET WORTH
Schedule A: Banks, Brokers, Savings, & Loan assocaition, Finance Companies or Credit Unions. List the names of all the institutions at which you maintain a deposit account and/or where you have obtained loans.
BANK 1
Name of Institution: Chase Bank
Name on Account Full Name
Balance on Deposit $
High Credit
Amount Owing $
Monthly Payment $
Secured by what Asset? Type a label
BANK 2Name of Institution: Chase Bank Name on Account Full NameBalance on Deposit $High Credit Amount Owing $ Monthly Payment $ Secured by what Asset? Type a label BANK 3Name of Institution: Chase Bank Name on Account Full NameBalance on Deposit $High Credit Amount Owing $ Monthly Payment $ Secured by what Asset? Type a label TOTAL BALANCE on DEPOSIT $
Schedule B: U.S. Governments, Stocks (Listed & Unlisted), Bonds (Gov't & Comm.), and Partnership Interests (General & Ltd.)ASSET 1
No. of Shares, Face Value (Bonds), or % of Ownership:
Indicate:
In Name of
Market Value
Pledged Yes No
_____
ASSET 2
ASSET 3
TOTAL $ *If unlisted security or partnership interest, provide current financial statements to support basis for valuation.
Schedule C: Real Estate Owned (and Related Debt, if Applicable)PROPERTY 1
Description of Property or Address:
Title in Name of Date Acquired Cost + Improvements Present Market Value
Mortgage or Land Contract
Balance Type a label
Monthly Payment Type a label
Mortgage Holder Type a label
PROPERTY 2
PROPERTY 3
PROPERTY 4
TOTAL $
Schedule D: Life Insurance CarriedPOLICY 1
Name of Company:
Face Amount: Cash Surrender: Loans: Beneficiary:
POLICY 2
Face Amount: Cash Surrender: Loans:
Beneficiary:
POLICY 3
POLICY 4
The information is presented as a true and accurate statement of my/our financial condition on the date indicated. This statement is provided for the purpose of obtaining and maintaining credit with a landlord/owner affiliated with Alliance Real Estate. I/we agree that if any material change(s) occur(s) in my/our financial condition that I/we will immediately notify Alliance Real Estate of said change(s) and unless Alliance Real Estate is so notified, Alliance Real Estate and its affiliated landlord/owner may continue to rely upon this financial statement and the representations made herein as a true and accurate statement of my/our financial condition.I/we authorize Alliance Real Estate to make whatever credit inquiries it deems necessary in connection with this financial statement. I/we authorize and instruct any person or consumer reporting agency to furnish to Alliance Real Estate any information that it may have or obtain in response to such credit inquiries.I/we also hereby certify that no payment requirements listed herein are delinquent or in default except as follows; if“NONE” so state.Type a label
I/we fully understand that it is a federal crime punishable by fine or imprisonment or both to knowingly make any falsestatements concerning any of the above facts, pursuant to 18 U.S.C. Section 1014.Applicant Signature: Signature* Date: Date* Social Security # Number Date of Birth Date* _____Spouse Signature: Signature Date: Date Social Security # Number Date of Birth Date