PERSONAL FINANCIAL STATEMENT
Name:Financial Position as of:
Residence Address:Business Address:
Address:Address:
City:City:
State:Zip:State:Zip:
Phone:Phone:
SS#:Fed ID#:
AssetsLiabilities
Cash on hand (Sched. A)Auto Loans (Sched. E)
Stocks, Bonds, Securities (Sched. B)Real Estate Mortgage (Sched. C)
Real Estate Market Value (Sched. C)Notes Payable Secured (Sched. F)
Business Interests (Sched. D)Notes Payable Unsecured (Sched. F)
Loans ReceivableLoans Payable (Sched. F)
Life Insurance Cash ValueInstallment Accts Payable (Sched. F)
Automobiles (Sched. E)Other Amounts Payable Secured (Sched. F)
Household ItemsOther Amounts Payable (Sched. F)
Collectible ItemsOther Liabilities
Business Equipment ItemsTotal Liabilities
Other AssetsNet Worth
Total AssetsTotal Liabilities & Net Worth
Schedule A—Personal Bank Accounts
Bank NamePhoneAccount NumberCurrent Balance
Total Cash On Hand$
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PERSONAL FINANCIAL STATEMENT
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Schedule B—Stocks, Bonds, Securities
DescriptionDate AcquiredTotal CostTotal Current Market Value
Total Stocks, Bonds, Securities$
Schedule C—Real Estate
AddressTitled ToCostYear PurchasedMarket ValueLien HolderOutstanding Mortgage
Total Real EstateMarket Value $Mortgage Payable $
Schedule D—Business Interests
DescriptionSole Prop/Partnership/CorporationTotal CostMarket Value
Total Business Interests$
Schedule E—Automobiles
YearMakeModelLien HolderTotal Owing
Total Automobiles$
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PERSONAL FINANCIAL STATEMENT
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Schedule F—All debts due owed except real estate and automobiles
Name of CreditorAddressPhoneSecured?Account NumberBalance Owed
Total Debts Due Owed Except Real Estate and Automobiles$
Authorization
I/We authorize World of Beer Franchising, Inc. to make whatever credit inquiries that it deems necessary in connection with this lease application or in the course of review or collection of any credit extended in reliance on this application. I/We authorize and instruct any person or consumer reporting agency to compile and furnish to the lessor any information that it may have to obtain in response to such credit inquiries and agree that such information, along with this application is approved. All information set forth in this application is declared to be a true representation of the facts and any willful misrepresentation on this application could result in criminal action.
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of sex or marital status. The federal agency which administers compliance with this law concerning this company is the Federal Trade Commission, Pennsylvania Avenue at Sixth Street, N.W., Washington, D.C.
Applicant:Date:
Signed By:Title:
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