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Personal Financial Statement

Customer Name

Street Address

Date of Birth

Social Security

Gross Earnings

Current Year

Previous Year

Assets

Cash

Stocks/401K

Receivables

Home Value

Investment Property

Auto (Personal)

Truck (Business)

Other Assets

Liabilities

Credit Cards Balance

Mortgage Balance

Loans/Fin Co. Balance

Other Liabilities

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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

March 4, 2016 10:18 am EDT

Personal Financial Statement Uploaded by CAG Truck Capital - credit@cagcorp.com IP 24.229.195.2, 185.93.229.6, 127.0.0.1, 198.71.237.55, 0.0.0.0, 24.229.195.2