Quantum Business Solutions Network  
Personal Financial Statement Form
Date:
 
Name:
Address:
City:
State / Zip:
Phone:
Cell:
Email:
Fax:
Assets
 
Cash on Hand in Banks
$
US Government Securities or Bank CD’s
 $
Accounts, Loans and Notes Receivable
 $
Other Stocks and Bonds
 $
Value of Businesses Owned
 $
Real Estate – Personal Residence
 $
Real Estate – Investment Property
 $
Automobiles – Number ( )
 $
Household Furnishings
and Personal Effects
 $
Other Assets -- list
 $
 
Liabilities
  
Notes Payable
 $
Real Estate – Personal Residence
 $
Real Estate – Investment Property
 $
Other Liabilities -- list
 $
 
Net Worth
$ (total assets minus total liabilities)
 
Annual Income
 
Salary – Self
$
Salary - Spouse
 $
Bonus and Commissions
$
Real Estate Net Income
 $
Other Income -- list
 $
Total Annual Income
$
 
Date: _______/________/________
Print Name: _______________________________________
Signature:_________________________________________
A PERSONAL OR BUSINESS FINANCIAL STATEMENT WILL BE REQUIRED OF ALL
POTENTIAL BUYERS BEFORE RECEIVING FINANCIAL INFORMATION ON ANY LISTING.
Fax this executed document to: (866) 480-7471
Quantum Business Solutions Network, Inc.
19900 MacArthur Boulevard, 11th Floor Irvine, California 92612
Telephone: (877) Qbs-net2 (727-6382) Facsimile: (866) 480-7471
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