NDA

Name*
First Name Last Name
Email*
Organization
Phone
Cell Phone
Address
Street Address City State / Province ZIP / Postal Code
Personal Financial Statement
* Strictly Confidential *
Assets
Cash on hand in banks
Marketable securities
Accounts, loans, and note receivable
Residence real estate value
Other real estate value
Value of business owned
Vehicles
Household furnishings and personal effects
Other assets (itemize)
Total Assets
Liabilities
Notes payable
Credit cards payable
Residence real estate mortgages
Other liabilities (itemize)
Total Liabilities
Net Worth (Assets minus liabilities)
Sources of Income
Salary
Dividends and interest
Bonus and commissions
Real estate income
Other income
Total Income
The undersigned certifies this financial information is provided by them personally and is true and correct.
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Listing Interest*
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Listing URL*
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Listing ID*
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Listing Price*
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Broker First Name*
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Broker Last Name*
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Broker Email*
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Personal Financial Statement* Strictly Confidential *