|
Name
|
Address
|
City,
State, Zip
|
Home
Phone
|
Cell
Phone
|
Business
Phone
|
Pager
|
| Best
time to call
|
Which
Number
|
Email
Address
|
| Have
you Chosen a Franchise?
|
If
yes, name of Franchise
|
Total Investment Size
|
Age
|
Part
I. Personal Financial Statement (PFS)
|
| Liabilities |
Assets |
Total
Credit Card Debt
$
|
Checking/Savings
$
|
Car
Loans/Leases
$
|
Certificate
of Deposit
$
|
Loans
against investments / Insurance
$
|
Money
Market Account
$
|
Student
Loans
$
|
Mutual
Funds
$
|
First
Mortgage
$
|
Stocks
$
|
Second
Mortgage
$
|
Stock
Options
$
|
Home
Equity Line
$
|
Bonds
$
|
Taxes
Due
$
|
Treasury
Bills
$
|
Taxes-Investments
(if cashed in)
$
|
Investment
Real Estate
$
|
Taxes-Retirement
(if cashed in)
$
|
401K
or 403B
$
|
|
IRAs
or Keogh
$
|
|
Pensions
$
|
|
Value
of Life Insurance
$
|
|
Value
of Private Business
$
|
|
Home
$
|
|
Car
$
|
|
Other
(Jewelry/ Furnishings)
$
|
TOTAL
LIABILITIES
$
|
TOTAL
ASSETS
$
|
TOTAL
NET WORTH
$
|
| |
|
| Part
II. Personal Income & Expense
Analysis (PIE) |
| INCOME |
| Source
of Income |
Annually |
| Gross
Salary - Principal |
$
|
| Spouse |
$
|
| Other
income |
$
|
| Rental |
$
|
| Interest |
$
|
| Dividend |
$
|
| Other |
$
|
Total
Income:
$
|
| |
|
| EXPENSES
All answers
should be on an annual basis |
| Mortgage
- Personal Residence (PITI) |
$
|
| Rental
Property (PITI) |
$
|
| Alimony |
$
|
| Automobile
Loans |
$
|
| Child
Care |
$
|
Credit
Card Expenses
(5%
of credit balances) |
$
|
| Educational
Expenses |
$
|
Income
taxes
(based
on highest amount of past 3 yrs) |
$
|
| Installment
Loans |
$
|
Insurance
(Medical/Life) |
$
|
Miscellaneous
(minimum
10% of total income) |
$
|
| Personal
Expenses |
$
|
Property
Taxes
(if
not included in mortgage payment(s)) |
$
|
| Rental
Property Expenses |
$
|
Utilities
(including
telephone and cable) |
$
|
| Other
Expenses |
$
|
Total
Expenses:
$
|
| Net
Discretionary Income (Income
minus Expenses) |
$
|
| Coverage
Ratio (Income/Expenses) |
$
|
| |
|
| Part
III. Questionnaire |
| How
is your personal credit? |
|
| Do
you know what your credit score is? |
|
| Have
you had a bankruptcy within the last
10 years? |
|
| How
much credit card debt, if any, do
you have? |
$
|
| Current/latest
occupation: |
|
| Current/latest
job title: |
|
| Current/latest
salary |
$
|
| Would
you still be retaining your current
salary? |
|
| Do
you own a home or other property? |
|
| How
much equity is in your home? |
$
|
| How
much equity is in the other property? |
$
|
| Do
you have a second income? |
|
| Available
cash to invest: |
$
|
| Are
all your taxes current (Business
or Personal)? |
|
| Have
you applied for an SBA Loan before? |
|
| Were
you approved? |
|
| Do
you owe any money for student loans? |
|
| Are
you current with your payments? |
|
| Are
you a US citizen? |
|
| Have
you ever been charged with, arrested
or convicted of any criminal offense
other than a minor vehicle violation? |
|
| Have
you ever owned a business or franchise
before? |
If yes,
please explain:
|
| Considering
other family income and your cash
reserves, what is the least amount
of yearly income you will need to
draw from your business during the
first year? |
|
Please
send to attention:
(or leave
blank and submit to first available
consultant) |
|
|
|
