Personal Financial Statement

First Name:
Last Name:
Social Security #:
Address:
City:
State:
Zip:
Business Name:
Business Address:
Phone:
Fax:
Date of Birth:
Years in Business:
Bank Information
Bank Name:
Account #:
Bank Phone:
Account Type:	Checking Savings
Assets
Cash on Hand or in Banks:
Business Ventures and Partnerships:
Real Estate Owned:
Automobiles:
Cash Value of Life Insurance:
Personal Property:
Other Assets:
TOTAL ASSETS:
Liabilities
Notes to Bank or other Financial Institutions:
Notes Payable to Banks Unsecured:
Notes payable to others:
Real Estate Mortgages Payable:
Other Liens Payable:
Unpaid Income Tax:
Other Debts, Cars, Credit Cards, etc.:
TOTAL LIABILITES:
TOTAL NETWORTH:
TOTAL LIABILITIES AND NETWORTH:
Sources of Income
Salary:
Income (Spouse):
Bonus and Commissions:
Dividends:
Real Estate Income:
Other Income:
General Information
Have you ever filed bankruptcy?	NoYes
Are you a defendant in any suits or legal action?	NoYes
Any other business connections?	NoYes

Authorization	I hereby authorize LSF Financial Group and /or Its Assigns to verify any credit information from whatever source it deems appropriate including, but not limited to, credit reporting bureaus and I further authorize our banks, trades, references and financial institutions to release by telephone or fax all credit information requested by LSF Financial Group and /or Its Assigns. We understand that any information obtained will be treated confidentially. It will be used only in assisting in securing lease financing. THE SIGNER CERTIFIES THE ABOVE HAS BEEN CAREFULLY READ AND IS TRUE AND CORRECT.

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