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Personal Financial Statement

Required Field

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


How would you prefer to be contacted?

Housing Status


Co-Applicant Information

If coapplying, you may apply for a separate account. If you are coapplying, complete all information for yourself and your spouse. You do not have to list spouse's separate property unless this is an application for a joint account. Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Co-Applicant Employment

Is the co-applicant employed?


Other Accounts

  • Account Name


  • Description


  • Amount Owed

  • Monthly Payment

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 Expenses

Other Expenses

  • Description

Contingent Liabilities

Other Contingent Liabilities

  • Description

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?

If yes to any of the above, please explain.

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

Add Another Marketable Security

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

Mortgage & Deed of Trust Owned

Add Another Mortgage & Deed of Trust Owned

Schedule 3: Real Estate Holdings - Mortgages or Liens

Mortgage or Lien

Add Another Mortgage or Lien

Schedule 4: Credit Cards And Loans Payable

Credit Card or Loan Payable

Add Another Credit Card or Loan Payable


I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize Nantahala Bank and Trust 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 Nantahala Bank and Trust 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.