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Assets
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Total
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Liabilities
|
Total
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| |
|
|
Cash
|
|
Accounts & notes payable
|
|
|
Negotiable securities
|
|
Unpaid income taxes
|
|
|
Accounts receivable
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Other unpaid account
|
|
|
Real estate market value residence
|
|
Amount owing on credit card(s)
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|
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Real estate - market value other
|
|
Loans on life insurance policies
|
|
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Receivable mortgages
|
|
Mortgages payable - residence
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|
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Insurance cash value
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|
Other mortgages or liens
|
|
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Personal property
|
|
Other debts
|
|
| |
|
|
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Total
|
$
|
Total
|
$
|
| |
|
|
Total assets
|
$
|
|
|
|
Less total liabilities
|
$
|
Will you require assistance to obtain financing?
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| |
|
|
|
Net worth
|
$
|
| |
|
|
How do you propose to fund to this investment? |
Do you have any judgements, liens or suits pending?
|
|
|
|
| What amount of cash can you commit?
|
|
Annual income
|
|
| |
|
|
Source_______________________
|
$_______
|
Salary or wages
|
|
|
Source_______________________
|
$_______
|
Bonuses
|
|
|
Source_______________________
|
$_______
|
Dividends or interest
|
|
|
Source_______________________
|
$_______
|
Partner/Spouse's income
|
|
|
Source_______________________
|
$_______
|
Other income
|
|
| |
|
|
Total cash investment
|
$_______
|
Total annual income
|
$
|