CONTRACTOR'S FINANCIAL STATEMENT As of (date):
Business Name: Address: City, State, Zip Phone: Kind Of Business: Individual Preferred/Authorized: Partnership Issued: Corporation Par Value: Per Share: Capital Stock (if Incorporated) License Number: Name of Owner, Partners Officers & Directors Title Number of Shares Owned
ASSETS
Cash on Hand: Cash in Bank: Accounts Receivable - Collectible: Not due: Within 60 days past due: Over 60 days past due: Notes Receivable - Collectible Secured: Unsecured: Inventory - (not pledged or assigned): Other Current Assets : (List)
LIABILITIES AND NET WORTH
Accounts Payable - Trade: Not Due: Past Due: Accounts Payable - Other: Notes Payable - Bank (Itemize below): Notes Payable - Other (Itemize below): Accrued Liabilities: (List) Federal and State Taxes: Other: Other Current Liabilities: (List)
Total Current Assets: Real Estate (Itemize below): Furniture and Fixtures: Machinery and Equipment: Trucks and Autos: Trust Deeds and Mortgages: First Liens: Junior Liens: Other Assets : (List)
Total Current Liabilities: Real Estate Encumbrances:: Other Liabilities: (List)
Capital Stock: Preferred: Common: Surplus (If Incorporated) Capital (If Unincorporated) Total Assets:
Sub Total Liabilities:
Total All Liabilities:
Total Net Worth (Assets - Liabilities):
SUPPLEMENTARY INFORMATION
Estimated earned profits on firm contracts in process: Estimated earned profit on cost-plus and fixed-fee contracts: Total contracts signed (whether or not work has commenced): Cost-Plus Contracts: Fixed-Fee Contracts: Firm-Bid Contracts: Total Sales for past 6 months: Net Profit for past 6 months: Income from other sources: Bank:
Are you defendant in any lawsuits?
Yes
No No No
If so, for how much are you being sued? Estimated Completion: ( % ) Estimated Completion: ( % ) Estimated Completion: ( % ) Are Any judgements outstanding against you? Yes If so, for how much ? Do you have any contingent liabilities not shown above? Yes If yes, please describe briefly: annually. How long in California? What year was this business entity started? if previously in business, give trade name, location & period of operation:
12 months 12 months per month Branch:
REAL ESTATE (continue on back if necessary)
Location & legal Description Name on Title Improvements (if any) Value of Land
Total Value of Land + Improv
Encumbrances
If Construction % Completed
Income per month
NOTES PAYABLE (continue on back if necessary)
Note Payable to: Terms Amount Security Remarks (Purpose of note, etc)
LENDING AGENCY REFERENCES: TRADE REFERENCES:
The undersigned certifies that the foregoing is a true and complete statement of the business financial condition, as of the above date and that said statement is submitted to Provident Bank for the express purpose of establishing credit with or affecting the extension of credit by said bank.
Signature:
Title: