Business Name of Applicant/Borrower_________________________________________________________ ASSETS LIABILITIES Cash on hand and in Banks $ Accounts Payable $ Savings Account $ Notes Payable to Banks and $ Others (Describe in Section 2) IRA or Other Retirement $ Installment Account (Auto) $ Account Mo. Payments $ Accounts & Notes Receivable $ Installment Account (other) $ Mo. Payments $ Life Insurance-Cash Surrender $ Loans on Life Insurance $ Value Only (Complete Section 8) Stocks and Bonds $ Mortgages on Real Estate $ (Describe in Section 3) (Describe in Section 4) Real Estate $ Unpaid Taxes $ (Describe in Section 4) (Describe in Section 6) Automobile-Present Value $ Other Liabilities $ (Describe in Section 7) Other Personal Property $ Total Liabilities $ (Describe in Section 5) Other Assets $ Net Worth $ (Describe in Section 5) Total $ Total $ SECTION 1 SOURCE OF INCOME CONTINGENT LIABILITIES Salary $ As Endorser or Co-Maker $ Net Investment Income $ Legal Claims & Judgments $ Real Estate Income $ Provision for Federal $ Income Tax Other Income (Describe Below)* $ Other Special Debt $ Description of other income: *Alimony or child support payments need not be disclosed in unless it is “Other Income” desired to have such payments counted toward total income.
Business Name of Applicant/Borrower_________________________________________________________ ASSETS LIABILITIES Cash on hand and in Banks $ Accounts Payable $ Savings Account $ Notes Payable to Banks and Others (Describe in Section 2) $ IRA or Other Retirement Account $ Installment Account (Auto) Mo. Payments $ $ Accounts & Notes Receivable $ Installment Account (other) Mo. Payments $ $ Life Insurance-Cash Surrender Value Only (Complete Section 8) $ Loans on Life Insurance $ Stocks and Bonds (Describe in Section 3) $ Mortgages on Real Estate (Describe in Section 4) $ Real Estate (Describe in Section 4) $ Unpaid Taxes (Describe in Section 6) $ Automobile-Present Value $ Other Liabilities (Describe in Section 7) $ Other Personal Property (Describe in Section 5) $ Total Liabilities $ Other Assets (Describe in Section 5) $ Net Worth $ Total $ Total $ SECTION 1 SOURCE OF INCOME CONTINGENT LIABILITIES Salary $ As Endorser or Co-Maker $ Net Investment Income $ Legal Claims & Judgments $ Real Estate Income $ Provision for Federal Income Tax $ Other Income (Describe Below)* $ Other Special Debt $ Description of other income: *Alimony or child support payments need not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income.