Personal Financial Statement

You may apply for a credit extension or financial accommodation individually or jointly with a co-applicant. This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-applicants if their assets and liabilities are sufficiently joined so that the statement can be meaningfully and fairly presented on a combined basis; otherwise, separate statements and schedules are required.

Required Fields

Are you applying individually or jointly?

Individually
Jointly

Applicant

Name Social Security Number Address City State Zip Code Phone Number E-mail Address Present Employer Position Employer Address City State Zip Code

General Questions

Have you ever gone through bankruptcy or had a judgment against you?

Are any of your assets pledged as collateral for debts other than your own?

Have you made a living will?

Number of dependents (if "none" check none) None

Marital Status (answer only if this financial statement is provided in connection with a request for secured credit or applicant is seeking a joint account with spouse.) (Unmarried includes single, divorced, widowed)

Married
Separated
Unmarried

Co-Applicant

Name Social Security Number Address City State Zip Code Phone Number E-mail Address Present Employer Position Employer Address City State Zip Code

General Questions

Have you ever gone through bankruptcy or had a judgment against you?

Are any of your assets pledged as collateral for debts other than your own?

Have you made a living will?

Number of dependents (if "none" check none) None

Marital Status (answer only if this financial statement is provided in connection with a request for secured credit or applicant is seeking a joint account with spouse.) (Unmarried includes single, divorced, widowed)

Married
Separated
Unmarried

Assets

Schedule 1

Receivables Due from Others

Name of Debtor Collateral Maturity Date Unpaid Balance Payment Amount Payment Frequency

 Add Another Schedule 1

Schedule 1 Total

Total Unpaid Balance

Schedule 2

Retirement Accounts

Type of Account Balance

 Add Another Schedule 2

Schedule 2 Total

Total Balance

Schedule 3

Investments: Stocks, Mutual Funds and CD's

Market Value Description In Whose Name(s) Registered

 Add Another Schedule 3

Schedule 3 Total

Total Market Value

Schedule 4

Life Insurance

Insured Insurance Company Beneficiary Face Value of Policy Cash Value

 Add Another Schedule 4

Schedule 4 Total

Total Cash Value

Schedule 5

Real Estate Owned - Residence

Address Type of Property Title in Name(s) of Monthly Income Year Acquired Cost Mortgage Balance Present Market Value Amount of Insurance

 Add Another Residence

Other Real Estate Owned - Other Than Residence

Address Type of Property Title in Name(s) of Monthly Income Year Acquired Cost Mortgage Balance Present Market Value Amount of Insurance

 Add Another Schedule 5

Schedule 5 Total

Total Market Value

Liabilities

Schedule 6

Real Estate Owned - Residence

To Whom Payable Payment Amount Payment Frequency Interest Rate (%) Maturity Date Unpaid Balance

Real Estate Owned - Other

To Whom Payable Payment Amount Payment Frequency Interest Rate (%) Maturity Date Unpaid Balance

 Add Another Schedule 6

Schedule 6 Total

Total Real Estate Owned - Residence Total Real Estate Owned - Other

Schedule 7

Loans Payable (Due within One Year)

Banks To Whom Payable Address Payment Amount Payment Frequency Collateral Unpaid Balance

 Add Another Schedule 7

Installment Loans

Others To Whom Payable Address Payment Amount Payment Frequency Collateral Unpaid Balance

 Add Another Schedule 7

Loan Payable - Other than to Banks

Others To Whom Payable Address Payment Amount Payment Frequency Collateral Unpaid Balance

 Add Another Schedule 7

Schedule 7 Total

Total Loans Payable (Due Within One Year) Total Installment Loans Total Loan Payable - Other Than To Banks

Assets & Liabilities

Assets	Amount
Cash in this Bank	Cash in this Bank
Cash in Other Banks	Cash in Other Banks
Receivables Due From Others (Schedule 1)	Receivables Due From Others (Schedule 1)
Retirement Accounts (Schedule 2)	Retirement Accounts (Schedule 2)
Investments: Stocks, Mutual Funds and CDs (Schedule 3)	Investments: Stocks, Mutual Funds and CDs (Schedule 3)
Life Insurance Total Cash Value (Schedule 4)	Life Insurance Total Cash Value (Schedule 4)
Real Estate Owned (Schedule 5)	Real Estate Owned (Schedule 5)
Other Real Estate Owned (Schedule 5)	Other Real Estate Owned (Schedule 5)
Automobiles	Automobiles
Personal Property	Personal Property
Other Assets (Detail Below)	Other Assets (Detail Below)
Other Assets Details
Total Assets	Total Assets

Liabilities	Amount
Loans Payable Banks (Due within 1 Year) (Schedule 7)	Loans Payable (Due Within One Year) (Schedule 7)
Installment Loans (Schedule 7)	Installment Loans (Schedule 7)
Loans Payable - Other Than To Banks (Schedule 7)	Notes Payable Others (Due within 1 year) (Schedule 7)
Credit Card Balances	Credit Card Balances
Income Taxes Payable	Income Taxes Payable
Other Taxes Payable	Other Taxes Payable
Loans on Life Insurance (Schedule 4)	Loans on Life Insurance (Schedule 4)
Real Estate Owned - Residence (Schedule 6)	Real Estate Owned - Residence (Schedule 6)
Real Estate Owned - Other (Schedule 6)	Mortgage/Liens on Other Real Estate Owned (Schedule 6)
Other Liabilities (Detail Below)	Other Liabilities (Detail Below)
Other Liabilities Details
Total Liabilities	Total Liabilities
Net Worth (Total Assets Less Total Liabilities)	Net Worth

Income

Round all amounts to the nearest $100

Attach separate sheet if you need more space to complete detailed schedule

Annual Income	Applicant	Co-Applicant
Salary	Salary	Salary
Commissions	Commissions	Commissions
Interest	Interest	Interest
Rental Net Income	Rental Net Income	Rental Net Income
Alimony, Child Support or Maintenance (you need not show this unless you wish us to consider it)	Alimony, Child Support or Maintenance	Alimony, Child Support or Maintenance
Dividends	Dividends	Dividends
Other	Other	Other
Total	Total	Total

Contingent Liabilities	Amount
Check here if none
As Endorser	As Endorser
As Guarantor	As Guarantor
Lawsuits	Lawsuits
For Taxes	For Taxes
Other (Detail Below)	Other (Detail Below)
Other Contingent Liabilities Details
Total Contingent Liabilities	Total Contingent Liabilities

Endorsement

The foregoing statement, submitted for the purpose of obtaining credit, is true and correct in every detail and fairly shows my/our financial condition at the time indicated. I/we will give you prompt written notice in any subsequent substantial change in such financial condition occurring before discharge of my/our obligations to you. I/we understand that you will retain this personal financial statement whether or not you approve the credit in connection with which it is submitted. You are authorized to check my/our credit and employment history or any other information contained herein.

THE UNDERSIGNED CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM HAS BEEN CAREFULLY REVIEWED AND THAT IT IS TRUE AND CORRECT IN ALL RESPECTS.

Date

Personal Financial Statement

Are you applying individually or jointly?

Applicant

General Questions

Have you ever gone through bankruptcy or had a judgment against you?

Are any of your assets pledged as collateral for debts other than your own?

Have you made a living will?

Marital Status (answer only if this financial statement is provided in connection with a request for secured credit or applicant is seeking a joint account with spouse.) (Unmarried includes single, divorced, widowed)

Co-Applicant

General Questions

Have you ever gone through bankruptcy or had a judgment against you?

Are any of your assets pledged as collateral for debts other than your own?

Have you made a living will?

Marital Status (answer only if this financial statement is provided in connection with a request for secured credit or applicant is seeking a joint account with spouse.) (Unmarried includes single, divorced, widowed)

Assets

Schedule 1

Receivables Due from Others

Schedule 1 Total

Schedule 2

Retirement Accounts

Schedule 2 Total

Schedule 3

Investments: Stocks, Mutual Funds and CD's

Schedule 3 Total

Schedule 4

Life Insurance

Schedule 4 Total

Schedule 5

Real Estate Owned - Residence

Other Real Estate Owned - Other Than Residence

Schedule 5 Total

Liabilities

Schedule 6

Real Estate Owned - Residence

Real Estate Owned - Other

Schedule 6 Total

Schedule 7

Loans Payable (Due within One Year)

Installment Loans

Loan Payable - Other than to Banks

Schedule 7 Total

Assets & Liabilities

Assets

Amount

Cash in this Bank

Cash in Other Banks

Receivables Due From Others (Schedule 1)

Retirement Accounts (Schedule 2)

Investments: Stocks, Mutual Funds and CDs (Schedule 3)

Life Insurance Total Cash Value (Schedule 4)

Real Estate Owned (Schedule 5)

Other Real Estate Owned (Schedule 5)

Automobiles

Personal Property

Other Assets (Detail Below)

Total Assets

Liabilities

Amount

Loans Payable Banks (Due within 1 Year) (Schedule 7)

Installment Loans (Schedule 7)

Loans Payable - Other Than To Banks (Schedule 7)

Credit Card Balances

Income Taxes Payable

Other Taxes Payable

Loans on Life Insurance (Schedule 4)

Real Estate Owned - Residence (Schedule 6)

Real Estate Owned - Other (Schedule 6)

Other Liabilities (Detail Below)

Total Liabilities

Net Worth (Total Assets Less Total Liabilities)

Income

Annual Income

Applicant

Co-Applicant

Salary

Commissions

Interest

Rental Net Income

Alimony, Child Support or Maintenance (you need not show this unless you wish us to consider it)

Dividends