Personal Financial Statement - Franchise Lenders

PERSONAL FINANCIAL STATEMENT (PFS)

The purpose of this form is to collect information for loan pre-qualification only (no cost / no obligation)

This information is current as of this date:(Required)

MM slash DD slash YYYY

Personal Information

Full Name(Required)

Home Phone(Required)

Business Phone

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Information

Business Name of Applicant/Borrower(Required)

Business Address (if available)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Type:(Required)

Corporation

S-Corp

LLC

Partnership

Sole Propiertor

Business Investment:(Required)

Start-up

Acquisition

Expansion

Refinance

Who's involved?(Required)

Married

Single

Do you have a Partner?

Personal Guarantor/co-signer?

.............ASSETS...............................................LIABILITIES...............

(ASSET) Cash On Hand (ASSET)(Required)

(LIABILITY) Credit Cards(Required)

(ASSET) Savings Accounts(Required)

(LIABILITY) Notes Payable to Banks and Others(Required)

(Personal Loan(s))

(ASSET) Money Owed To You(Required)

(LIABILITY) Installment Account (Auto Loans)(Required)

(ASSET) 401K or IRA Retirement Account(Required)

(LIABILITY) Installment Account (Student Loan)(Required)

(ASSET) Real Estate(Required)

(Describe in Section 3)

(LIABILITY) Loan(s) Against Life Insurance(Required)

(ASSET) Life Insurance(Required)

Cash Surrender Value Only……(Not Term Policy)

(LIABILITY) HELOC/2nd Mortgage(Required)

(Describe in Section 3)

(ASSET) Automobiles(Required)

(Owned or Financed - Not Leased)

(LIABILITY) Mortgages on Real Estate(Required)

(Describe in Section 3)

(ASSET) Other Personal Property(Required)

(Describe in Section 2))

(LIABILITY) Unpaid Taxes or other personal debt.(Required)

(Liability) (Describe in Section 4)

Other Assets-Money already invested(Required)

(Business/Franchise fees paid) (Describe in Section 2)

(LIABILITY) Other Liabilities -Money already invested(Required)

(Business/Franchise fees paid) (Describe in Section 2)

Assets Total

Total Liabilities

Net Worth

Source of income

Salary(Required)

Net Investment Income(Required)

Real Estate Income(Required)

Other Income (Describe in section one)(Required)

Source of income Total

Contingent Liabilities

As Endorser or Co-Maker(Required)

Legal Claims & Judgments(Required)

Provision for Federal Income Tax(Required)

Other Special Debt(Required)

Contingent Liabilities Total:

Section 1.

Description of Other Income (Alimony or child support payments should not be disclosed in “Other Income” unless it is desired to have suchpayments counted toward total income)

Section 2.

Other Personal Property and Other Assets. (Describe, and, if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment and, if delinquent, describe delinquency.)

Section 3. Real Estate Owned.

Present Market Value

Property A

Property B

Property C

Mortgage Balance

Property A

Property B

Property C

Balance on HELOC or 2nd Mortgage

Property A

Property B

Property C

Section 4.

Other Liabilities. (terms of payment and, if delinquent, describe delinquency.)

CERTIFICATION: (to be completed by each person submitting the information requested on this form and the spouse of any 20% ormore owner when spousal assets are included) By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting information submitted with this form is true and complete to the best of my knowledge. I understand that this form is being review for SBA loan Pre-qualification only and will rely on this information when making decisions regarding an application for a loan.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

Print Name(Required)

Personal Financial Statement (PFS)

PERSONAL FINANCIAL STATEMENT (PFS)

Personal Information

Business Information

.............ASSETS...............................................LIABILITIES...............

Source of income

Contingent Liabilities

Section 1.

Section 2.

Section 3. Real Estate Owned.

Section 4.

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