Personal Financial Statement

Date of Financial Statement

Are you applying as an individual or with a co-applicant? Individual Co-Applicant

Applicant

Account Number First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Home Address City State Zip Code Work Phone Number Home Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted? Home Phone Work Phone Email Other

Other Preference

Housing Status

Housing Status Options Own Rent Other

Explain Monthly Mortgage or Rent Payment

Employment

Employment Status Employed Not Employed

Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Co-Applicant

How would you prefer to be contacted? Home Phone Work Phone Email Other

Other Preference

Housing Status

Housing Status Options Own Rent Other

Explain Monthly Mortgage or Rent Payment

Employment

Employment Status Employed Not Employed

Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Assets

Bank Account Balance Stocks & Bonds Owned (Schedule 1) IRA / Keogh / Pension Amounts Accounts / Notes Receivable (Schedule 2) Deeds of Trusts Owned (Schedule 2) Real Estate Market Value(s) (Schedule 3) Other Investments / Partnerships

Other Accounts

Account Name	Total Value
Account Name	Total Value

Automobiles

Description	Total Value
Description	Total Value

Additional/Other Assets

Additional Personal Property Other Assets (attach detail)

Liabilities

Liability	Amount Owed	Monthly Payment
Income Taxes Payable	Income Taxes Payable	Monthly Income Taxes Payable
Other Taxes Payable	Other Taxes Payable	Monthly Other Taxes Payable
Charge Cards Payable (Schedule 4)	Charge Cards Payable (Schedule 4)	Monthly Charge Cards Payable
Installment Loans (Schedule 4)	Installment Loans (Schedule 4)	Monthly Installment Loans
Loans on Life Insurance	Loans on Life Insurance	Monthly Loans on Life Insurance
Real Estate Debt (Schedule 3)	Real Estate Debt (Schedule 3)	Monthly Real Estate Debt

Loans on Stocks & Bonds

Title	Amount Owed	Monthly Payment
Title	Amount Owed	Monthly Payment

Other Liabilities

Description	Amount Owed	Monthly Payment
Description	Amount Owed	Monthly Payment

Liability & Asset Totals

Assets Liabilities Monthly Payments Net Worth (Assets - Liabilities)

Annual Income

Applicant Salary Co-Applicant's Salary Dividend / Bond Income Interest Income Rental Income

Other Income

Description	Annual Total
Description	Annual Total

Total Annual Income:

Annual Expenses

Interest Expense Property Taxes Income & Other Taxes Mortgage Payments/Rent Credit Card Payments Loan Payments Insurance Alimony & Child Support

Other Expenses

Description	Annual Total
Description	Annual Total

Total Annual Expenses:

Contingent Liabilities

As an Endorser As a Guarantor As a Co-signer On Damage Claims Letters of Credit

Other Contingent Liabilities

Description	Total Amount
Description	Total Amount

Total Contingent Liabilities

General Information

If you are co-applying, these questions apply to both you and your spouse.

Are any assets held in Trust? Yes No

Please Explain

Are any assets pledged or debts secured except as shown? Yes No

Please Explain

Have you ever had a repossession? Yes No

Please Explain

Have you ever had a bankruptcy or had a judgment against you? Yes No

What year? Please Explain

Have you ever been a principal or guarantor of a firm that declared bankruptcy? Yes No

What year? Please Explain

Are you a party to any claim or lawsuit? Yes No

Please Explain

Has there been an IRS audit in the past 3 years? Yes No

Please Explain

If yes, has the audit been settled? Yes No

Please Explain

Schedule 1: Marketable Securities

Are any of your securities restricted? Yes No

Do you own 10% or more of the outstanding stock of any company? Yes No

Marketable Security

Title In Name of How Held Description Pledged # of Shares or Bond Amount Present Market Value

Total Present Market Value

Schedule 2: Notes Receivable - Mortgage & Deed of Trust Owned

Mortgage & Deed of Trust Owned

Name of Debtor Collateral How Held Date of Note Maturity Date Monthly Payment Unpaid Balance

Total Monthly Payment Total Unpaid Balance

Schedule 3: Real Estate Holdings - Mortgages or Liens

Mortgage or Lien

Name of Lender How Held Property Type Date Purchased First Mortgage Second Mortgage Monthly Payment Market Value Original Cost Percentage Owned Property Address City State Zip Code

Total Monthly Payment Total Owed

Schedule 4: Credit Cards And Loans Payable

Credit Card or Loan Payable

Name of Creditor	Monthly Payment	Current Balance
Name of Creditor	Monthly Payment	Current Balance

Total Monthly Payment Total Current Balance

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Bank Name to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize Bank Name to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature Date

Co-Applicant's Signature Date