Financial Statement For Businesses Page 2

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Current Liabilities
Accounts/Taxes Payable
Name of Tax Agency or Creditor
Address
Balance Due
Mo. Payment
$
$
Dept. Use Only
Section B
Available Credit Sources
Bank Charge Cards, Credit Unions, Savings and Loans, etc.
Type of Account
Name and Address of
Amount Owed
Minimum Monthly
Business or
Available
or Card
Financial Institution
Payment
Personal
Credit
$
$
$
Life Insurance Policies owned with business as a beneficiary
Name Insured
Company
Policy Number
Type
Face Amount
Loan Value
$
$
Business Assets
Machinery, Furniture, Fixtures, etc.
Description
Market Value
Balance Due
Equity
$
$
$
Vehicles and Heavy Equipment
Make
Year
License Number
Market Value
Balance Due
Equity
$
$
$
Real Property Assets
Ownership
Physical Address
County
Market Value
Mortgage Balance
Equity
$
$
$
Dept. Use Only
Section C
DE 926C Rev. 13 (5-15) (INTERNET)
Page 2 of 4

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