Personal Guarantor Financial Statement
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1Personal Guarantor Financial Statement
Guarantor name: ____________________________________ (use separate sheet for each guarantor) Date: ______________
ASSETS
IN EVEN DOLLARS
LIABILITIES AND NET WORTH
IN EVEN DOLLARS
Cash on hand & in banks (see Schedule A)
$
Notes Payable (see Schedule A)
$
CD’s & Savings (see Schedule A)
Banks – Secured
US Govt Securities (see Schedule B)
Banks – Unsecured
Listed Securities (see Schedule B)
Chattel Mtgs., Liens
Unlisted Securities (see Schedule B)
Others
Other Equity Interests (see Schedule B)
Real Estate Mortgages Payable (see Schedule B or C)
Investment in Own Business (see Sch. B)
Accounts & Notes Receivables
Other Debts: Attach an itemized list
Real Estate Owned (see Schedule C)
Automobiles
Personal Property
Other Assets: Attach an itemized list
TOTAL LIABILITIES
$
NET WORTH
$
TOTAL LIABILITIES & NET WORTH*
$
TOTAL ASSETS
$
*Total liabilities and net worth must equal assets
Schedule A: Banks, Brokers, Savings & Loan Assoc. Finance Companies or Credit Unions. List here the names of all the institutions at which you
maintain a deposit account and/or where you obtained loans.
Balance on
Amount
Monthly
Name of Institution
Name on Account
High Credit
Secured by What Assets
Deposit
Owing
Payment
$
$
$
$
$
$
$
$
$
$
$
$
TOTAL:
$
TOTALS:
$
$
Schedule B: US Governments, Stocks (Listed & Unlisted), Bonds (Govt. & Common), Partnership Interests (General & Ltd.) and Investments in Own
Business.
Indicate:
Pledged
Number of Shares Face
1. Agency or name of company issuing security or name of partnership
Value (Bonds) or % of
*Market
2. Type of investment or equity classification
Ownership
In name of:
Yes or No
Value
3. Number of Shares, bonds or % of ownership held
TOTAL:
$
Schedule C: Real Estate Owned (and related debt, if applicable)
Description
Title in
Date
Cost +
Present
Mortgage or
Land Contract
Payable
of Property or Address
Name of
Acquired
Improvements
Market Value
Bal. Owing
Mo. Pmt.
Holder
TOTALS:
$
$
$
$
The undersigned (s) understand that Capital Relay and its assigns may wish to verify or investigate the undersigned parties credit and expressly
authorize any verification or investigation that you deem necessary. The undersigned also hereby certifies and represents to Capital Relay and its
assigns that the financial information is: true, accurate and complete in all material respects; that each of the assets set forth therein is owned
free of any interest or claim of interest thereto of any other person (except as specifically noted); that no undisclosed liens, encumbrances or
defects in or upon the assets listed herein or any undisclosed liability; that all taxes owed by the undersigned have been fully paid and
discharged, except taxes not yet due and payable without penalty; and that there are not pending claims, actions, proceedings, judgments or
liens on any of the undersigned’s property, except as fully disclosed in said statement. Any untrue statement may be a condition of default of the
lease. If married, spouse’s assets & liabilities must be listed and included above and spouse must sign below:
Guarantor Signature: ____________________________________________ Date: ____________________
Spouse’s Signature: _____________________________________ ________ Date: _____________________
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