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Five Star Leasing, LLC
P.O. Box 6784
Helena MT 59604
State
State
AMOUNT
$
$
Applicant Signature Date Co-Applicant Signature Date
$
Other
401K / IRA / Other
Income Property
Name
Business Phone #
City
Personal Residence &
Other Real Estate
Investments
CONTINGENT LIABILITIES:
Endorser on Notes
$Total ContingentTotal Income Total Expenses
Other Income
$
Other Expenses
Taxes
Other Contingent
Federal & State Income Tax
Real Estate Loan Payments
Payments on Contracts
Estimated Living Expenses
Guarantor on Notes
Net Worth $
Total Liabilities
# of Years
SC
H.
E Other Assets &
Personal Property
ANNUAL INCOME: ANNUAL EXPENSES:
Occupation
SC
H.
C
Mailing Address (if different)
SC
H.
C
Credit Cards
Unimproved Land
SC
H.
A Cash, Savings,
Checking, Etc.
Stocks, Bonds, Mutual
Funds & Retirement
AccountsSC
H.
B
Life Insurance
Accounts & Notes
Receivable
Salaries and Wages
Dividends and Interest
SC
H.
D
Gross Rental Income
Net Business Income
Other
I (We) certify that the information provided is true and correct to the best of my (our) knowledge and belief. I (We) may be required to supply additional information and to provide
security for the requested loan. I (We) further agree that whether or not the loan is closed, all such title evidence or other title examination expenses shall be paid by me (us) unless I
(We) have exercised the right of recission. I (We) further agree and consent that the bank may obtain a credit report or any other information relating to my (our) income or financial
position and agree to pay any cost for obtaining such information. From time-to-time you may verify and exchange information on me (us) with credit reporting agencies. I (We)
acknowledge that an application has been made by the individual(s), partnership(s), corporation(s) or any other legal entity(ies) named below to Five Star Leasing. I (We) futher
agree, consent and authorize Five Star Leasing, LLC to obtain credit and deposit information, including financial records and income tax records from any accountant, attorney or
other creditor. I (We) futher agree that the authorization is in full force and effect until cancelled by me (us).
Property Tax Assessments
Other Institutions
Cash Value
Marketable Securities
Accounts, Loans &
Notes Payable
(Non-RE)SC
H.
F
Other Liabilities
Notes & Loans Payable
(RE Secured)Residence
Other Institutions
Other Retirement
Occupation
LIABILITIES
Total Assets
OtherUnimproved Land
Insurance Loans
Residence
ASSETS
# of Years
Physical Address
SC
H.
D
Income Property
Revolving Accounts
Cell Phone #
Zip
SSN
City
Mailing Address (if different)
Physical Address
Business Phone #
AP
PL
ICA
NT
Home Phone #
AMOUNT
Financial Statement as of ____________
Home Phone #
SSN
CO
-AP
PL
ICA
NT
Cell Phone #
Zip
Name
CKING CD SVING BalanceInterest Paid
to You
Total $
Number
SharesRegistered Name
Date of
ValuationPrice / Share
Total
BenificiaryFace
AmountCash Value
Loans on
Policy
Total $ $ $
Percent Owned /
Property TypeValue
Monthly
Income
Monthly
Payment
Payble to
Whom
%/
%/
%/
%/
%/
Total $ $ $
ValueRecreational Vehicles
& BoatsValue
Personal
PropertyValue Value
Yr: Yr: Make: Furniture: $
Yr: Yr: Make: Equipment: $
Yr: Yr: Make: Jewlery: $
Yr: Yr: Make: Other:
$ Subtotal $ Subtotal $
$
Collateral PledgedName on
AccountMaturity Date
per
per
per
per
per
per
Total $
Margin or Pledged
(Y/N)
REAL ESTATE OWNED
Account Pledged (Y/N)
Insured
Make:
Auto:
Loan Balance
$
Name of Company
Payable to Whom
Make:
Make:
Property Address
Make:
ACCOUNTS, LOANS AND NOTES PAYABLE TO BANKS AND OTHERS (Include Credit Cards)
OTHER ASSETS AND PERSONAL PROPERTY
How Payable
$
Total
Subtotal
Automobiles
Balance Due
RV & Boat:
Personal:
$
Subtotals
Total Value
$
Description
SC
HE
DU
LE
F
SC
HE
DU
LE
C
SC
HE
DU
LE
D
SC
HE
DU
LE
E
CASH AND LOCATION OF BANK ACCOUNTS
STOCKS AND BONDS (Include Interest in Closely Held Businesses)
LIFE INSURANCE
Institution Where Located Date CD Matures
SC
HE
DU
LE
A
SC
HE
DU
LE
B
