Fill and Sign the Print a Business Financial Statement Form

You must complete this Business Financial Statement and attach a copy of your most current Income Statement and Balance Sheet along with a copy of your year end Profit and Loss Statement and Balance Sheet. BUSINESS FINANCIAL STATEMENT STATEMENT OF FINANCIAL STATEMENT AS OF STREET ADDRESS CITY AND STATE TO PLEASE ANSWER ALL QUESTIONS AND FILL IN ALL BLANKS ASSETS (omit cents) LIABILITIES (omit cents) Cash in Banks $ Accounts Payable $ Cash on hand $ Notes Payable on Merchandise $ Accounts Receivable $ Other Notes Payable $ Notes Receivable $ Borrowed from Banks Secured $ Accounts and Notes Receivable from Officers, Partners, and Employees $ Borrowed from Banks Unsecured $ $ Borrowed from Others (Whom?) $ Merchandise Receivables Secured by Real Estate $ Income Taxes: Due on last Year’s Profits Accrued on Current Year Profits $ Receivables Secured by Mortgages $ $ Receivables Secured by Deeds or Trusts $ Other Liabilities or Accruals Mortgages on Real Estate (Describe Below) Machinery, Tools, Furniture and Fixtures Notes and Accts., Receivable from Affiliated Cos. $ Other Assets (Describe) $ Other Mortgages, Liens, Security Interest or Encumbrances. (Describe Below) $ TOTAL LIABILITIES $ CAPITAL $ SURPLUS $ NET WORTH $ TOTAL (Must agree with Total Assets) $ TOTAL ASSETS If any of the above have been pledged, give details: Description Amount $ To Whom If incorporated or licensed, in what Country or State? When formed? Description and Location of Real Estate Listed in Financial Statement Title Held in name of Authorized Capital? $ Subscribed Capital? $ Paid in Cash? $ Paid Otherwise? $ How Paid? $ Cost Plus Improvements Present Market Value Amount of Mortgages How Payable The undersigned hereby authorizes Thrifty Rent-A-Car System, Inc. to obtain and exchange credit data; warrants that all information is true and accurate and was taken from the books and records of the above named business as of the date below. NAME DATE SIGNED