Vending Machine Manufacturer

Accessit Corp
Net Worth Statement Form

For those applying for a Master Distributorship or Executive Platinum Distributorship.

To complete the assessment process of your application please fill out the following Net Worth Statement.

The following information submitted will be held totally confidential and to be used solely for the assessing of potential applicants by Accessit Corp.
Please state all values in US Dollars.

Date:	5/20/2018 11:52:41 PM
Name:
Phone:
Email:
Country:
Assets	Market Value
Cash On Hand:	$
Checking Account(s):	$
Savings Account(s):	$
Money Market Funds / Money Market Deposit Accounts:	$
Time Deposits:	$
Savings Bonds:	$
Investment Assets:
Stocks:	$
Bonds:	$
Mutual funds:	$
Real Estate
Home:	$
Other:	$
Cash Value of Life Insurance/Annuities	$
Partnership and Business Interest	$
Other:	$
Retirement Assets:
IRA/Keogh Account	$
Employee Retirement Fund:	$
Other:	$
Consumption Assets
Home Furnishings/Appliances	$
Sports and Hobby Equipment	$
Automobiles/Vehicles	$
Other:	$
Other
	$
	$
	$

Liabilities	Market Value
Past-due Bills for Services, Rent, etc.	$
Past-due Taxes	$
Credit Cards/Charge Accounts	$
	$
	$
	$
	$
Consumer Installment Debt
Automobile	$
	$
Real Estate Debt
Home	$
	$
Pledges: Charities, Churches, etc.	$
Other
	$
	$

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Creating Wealth For You Is Our Business

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Accessit Corp. A Vending Machine Manufacturer!

Copyright Infringement: All of our marketing materials which include internet, printed show handouts, brochures, and all advertising is copyrighted and owned by Accessit Corp. Unauthorized duplication of any of these copyrighted materials will be subject to prosecution to the fullest extent of the law.