Personal Financial Statement

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


How would you prefer to be contacted?

Housing Status

Housing Status Options


Employment Status


How would you prefer to be contacted?

Housing Status

Housing Status Options


Employment Status


Other Accounts

Account Name Total Value


Description Total Value

Additional/Other Assets


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

Loans on Stocks & Bonds

Title Amount Owed Monthly Payment

Other Liabilities

Description Amount Owed Monthly Payment

Liability & Asset Totals

Annual Income

Other Income

Description Annual Total

Annual Expenses

Other Expenses

Description Annual Total

Contingent Liabilities

Other Contingent Liabilities

Description Total Amount

General Information

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

Are any assets held in Trust?
Are any assets pledged or debts secured except as shown?
Have you ever had a repossession?
Have you ever had a bankruptcy or had a judgment against you?
Have you ever been a principal or guarantor of a firm that declared bankruptcy?
Are you a party to any claim or lawsuit?
Has there been an IRS audit in the past 3 years?
If yes, has the audit been settled?

Schedule 1: Marketable Securities

Are any of your securities restricted?
Do you own 10% or more of the outstanding stock of any company?

Marketable Security

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

Mortgage & Deed of Trust Owned

Schedule 3: Real Estate Holdings - Mortgages or Liens

Mortgage or Lien

Schedule 4: Credit Cards And Loans Payable

Credit Card or Loan Payable

Name of Creditor Monthly Payment Current Balance


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.