Form Ri 433 B-Collection Information Statement Businesses Page 4
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Section 5 BANK ACCOUNTS.
List all checking and savings accounts. (If you need additional space, attach a separate sheet.)
Continued Type of
Full Name of Bank or Financial Institution
Bank
Current
Account
Account No.
Account Balance
Checking
Name ______________________________________
_______________________
$________________
St. Address _________________________________
City/State/Zip ________________________________
Checking
Name ______________________________________
_______________________
$________________
St. Address _________________________________
City/State/Zip ________________________________
Savings
Name ______________________________________
_______________________
$________________
St. Address _________________________________
City/State/Zip ________________________________
Name ______________________________________
_______________________
$________________
St. Address _________________________________
City/State/Zip ________________________________
Name ______________________________________
_______________________
$________________
St. Address _________________________________
City/State/Zip ________________________________
Total Bank Account Balances
$________________
Section 5
CASH ON HAND.
Include any money that you have that is not in the bank.
Continued
Total Cash on Hand
$ _______________
AVAILABLE CREDIT.
List all lines of credit, including credit cards.
Full Name of
Credit Institution
Credit Limit
Amount Owed
Available Credit
Name_______________________________________
$ _______________ $ _______________ $ _______________
Street Address _______________________________
City/State/Zip _______________________________
Name_______________________________________
$ _______________ $ _______________ $ _______________
Street Address _______________________________
City/State/Zip _______________________________
Total Credit Available
$ _______________
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