Personal Financial Statement
Principal #1
|
|
Name:
|
|
City, State, Zip: |
|
Date of Birth: |
|
Business Name: |
|
City, State, Zip: |
|
Length of employment: |
|
Address: |
|
Social Security #: |
|
Position or Occupation: |
|
Bus. Address: |
|
Length at present employment: |
|
Principal #2 (if applicable)
|
|
Name: |
|
City, State, Zip: |
|
Date of Birth: |
|
Business Name: |
|
City, State, Zip: |
|
Length of employment: |
|
Address: |
|
Social Security #: |
|
Position or Occupation: |
|
Bus. Address: |
|
Length at present employment: |
|
Have (either of) you or any firm in which you were a major owner ever declared bankruptcy, or settled for debts for less that the amounts owed? If yes, please provide details by clicking here. |
No
|
Yes
|
When
|
Are (either of) you a defendant in any suit or legal action? |
No
|
Yes
|
When
|
Are (either of) you presently subject to any unsatisfactory judgments or tax liens? |
No
|
Yes
|
When
|
When, if ever, have (either of) you been audited by IRS? |
No
|
Yes
|
When
|
ASSETS
|
IN EVEN DOLLARS
|
Cash on Hand |
|
Non-Marketable Securities - See Schedule B |
|
Restricted or Control Stocks |
|
Partnership Interest - See Schedule C |
|
Loans Receivable |
|
Marketable Securities - See Schedule A |
|
Securities held by Broker in Margin Accounts |
|
Partial Interest in Real Estate Equities |
|
Real Estate Owned - See Schedule D |
|
Automobiles and Other Personal Property |
|
Other Assets - Itemize |
|
|
|
|
|
|
|
Total Assets |
|
LIABILITIES
|
IN EVEN DOLLARS
|
Notes Payable to Banks |
|
Amounts Payable to Others |
|
Accounts and Bills Due |
|
Other Unpaid Taxes and Interest |
|
Due to Brokers |
|
Loans on Life Insurance - See Schedule E |
|
Unpaid Income Tax |
|
Real Estate Mortgages
Payable See Schedule D |
|
Other Debts - Itemize |
|
|
|
|
|
|
|
Total Liabilities |
|
Net Worth |
|
Total Liabilities & Net Worth |
|
ANNUAL SOURCE OF INCOME
|
|
Salary, Bonus & Commissions
|
|
Real Estate Income
|
|
TOTAL
|
|
Net Income
|
|
Dividends
|
|
Less Living Expenses
|
|
CONTINGENT LIABILITIES
|
|
Do you have any Contingent Liabilities |
|
On Leases or Contracts |
|
Other Special Debt |
|
As Endorser, Co-Maker, or Guarantor |
|
Legal Claims |
|
Amount of Contested Income Tax Liens |
|
If your application for business credit is denied, you have the right to a written statement of the specific reason(s) for denial. To obtain the statement, please contact Amerifund, 9019 E. Bahia Dr., # 100 , Scottsdale, AZ, 85260, (480) 607-1122 within 60 days from the date of our decision. We will send you a written statement of the reason(s) for the denial within 30 days of receiving your request for the statement.
NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act, the federal agency that administers compliance with this law concerning this credit is the Federal Deposit Insurance Corporation, 25 Ecker Street, Suite 2300, San Francisco, CA.
I certify that the above given information given for the purpose of obtaining credit is true and correct. I authorize the person or firm to whom this application is made, any credit bureau or investigative agency employed by such person to investigate the references herein listed or other persons pertaining to my credit. I understand the terms of this instrument are not binding on Amerifund until accepted in writing by them.
_______________________________________________________
Signature, Title, Date
_______________________________________________________
Signature, Title, Date
Don't forget to include:
Last 2 years personal tax returns (complete copies)
Last 2 years business tax returns (complete copies)
Current business financial statement and/or projection on new business
Resume on all key principals
Business Plan
Fax the completed form to: 800-211-3072, or
Mail the completed form to:
Amerifund, Inc.
9019 E. Bahia Dr., # 100
Finance
Programs | Items to
Include | Application Form | Request
Info | Contact Us
News & Links | Repeat
Clients | Testimonials | Preferred
Partners
Finance Wizard | Employment
| Site Map | Financing
FAQs | Home