Allied Systems The Dollar Stores SBA Loan Worksheet
 

NAME: _________________________________________________________________________

 ADDRESS: _____________________________________________________________________        

CITY: __________________________________________ STATE: ____________ZIP: _________

 PHONE: __________________________E-MAIL: _______________________________________

 Section I                                                                        

ASSETS:    LIABILITIES:  
Cash in Bank:  $______________   Mortgages
 From Section II: 		 $______________                
       
Stocks & Bonds:    $______________ Credit Cards Balance:    $______________
       
Automobiles:   $______________ Auto Loans: $______________
       
Real Estate
From Section II:		 $______________ Installment Loans:  $______________
       
Retirement Acct: $______________  2nd Mtg./Line of Cr. $______________
       
Personal Property: $______________ Other Debts:    $______________
       
Other Assets:  $______________    
       
Total Assets:  $______________ Total Liabilities: $_____________
       

Section II                    

Real Estate  Current Value Date Purchased  Mortgage      Balance               Monthly Pmt.
           
Property 1 $ _________ _________   $ _________ $ _________
           
Property 2 $ _________ _________   $ _________ $ _________
           
Property 3 $ _________ _________   $ _________ $ _________
           
Total:  $ _________ _________   $ _________ $ _________

 

Section III
Please Check any credit problems you have during the last seven years:     
                                                                   

_____ Bankruptcy   _____ Charge-offs   _____ Slow Pays
         
_____ Judgments    ____ Tax Liens        ____ Law suits against you

A minimum of 30% cash injection is required. 
How much Liquid Capital (cash) do you have to put towards the purchase of this business?  $________________.

 

__________________________________________________   ___________________
Signature     Date

PRINT OUT THIS FORM FIRST, THEN FAX COMPLETED INFORMATION TO 702-891-8778