Personal Financial Statement

Date of Statement Name * Social Security Number Employer Co-Applicant Name Co-Applicant Social Security Number Co-Applicant Employer Email * Home Phone * Address City State Zip Code Business Phone Schedule 1: Cash - checking, savings, on hand Schedule 2: Securities - stocks, bonds, mutual funds Notes & contracts receivable Retirement Funds (eg. IRAs, 401(k)) Life insurance (cash surrender value) Personal Property, HHGS Real Estate Owned Other Total Assets Current Debt (Accounts Payable) Real estate mortgages Taxes payable Total Liabilities Net Worth

GROSS ANNUAL INCOME

Year Ended
Salary or Wages
Bonus and Commission
Dividends and Interest
Rental and Lease Income
Other Income
Total Annual Income

MONTHLY EXPENSES

Payments on Mortgages
Payments on All Other Loans
Other Expenses
Other Expenses 1
Other Expenses 2
Total Monthly Expenses

CONTINGENT LIABILITY

As a co-maker or guarantor or leases
As a partner or officer in any other venture
Defendant in any legal action
Total Contingent Liability

Schedule 1: Checking and Savings Accounts

Bank Name 1	Account Holder Name 1	Type(s) of Account 1	Balance 1
Bank Name 2	Account Holder Name 2	Type(s) of Account 2	Balance 2
Bank Name 3	Account Holder Name 3	Type(s) of Account 3	Balance 3
		Total

Schedule 2: Securities/stocks/bonds/mutual funds/stock

Name of Investment 1	Date of Acquisition 1	Number of Shares 1	Price Per Share 1	Total Value 1
Name of Investment 2	Date of Acquisition 2	Number of Shares 2	Price Per Share 2	Total Value 2
Name of Investment 3	Date of Acquisition 3	Number of Shares 3	Price Per Share 3	Total Value 3
			Total

Schedule 3: IRA's, 401(k), Retirement Accounts

Bank/Brokerage	Amount	Name	Total Value
Bank/Brokerage	Amount	Name	Total Value
Bank/Brokerage	Amount	Name	Total Value
		Total

Schedule 4: Life Insurance

Company Name/Person Insured	Beneficiary	Face Amount	Cash Value
Company Name/Person Insured	Beneficiary	Face Amount	Cash Value
Company Name/Person Insured	Beneficiary	Face Amount	Cash Value
		Total Cash Value

Schedule 5 & 7: Real Estate

Description/Location	Creditor Name	Monthly Payment	Amount Due	Market Value
Description/Location	Creditor Name	Monthly Payment	Amount Due	Market Value
Description/Location	Creditor Name	Monthly Payment	Amount Due	Market Value
			Total Cash Value	Total Cash Value

Schedule 6: Accounts Payable & Installment Loans

Creditor Name	Collateral	Monthly Payment	Balance Due
Creditor Name	Collateral	Monthly Payment	Balance Due
Creditor Name	Collateral	Monthly Payment	Balance Due
		Total Cash Value

The information contained in this statement for the purpose of obtaining, or maintaining credit with you on behalf of the undersigned, or persons, firms or corporations in whose behalf may either severally or jointly with other execute a guaranty in your favor. Each undersigned understands that your are relying on the information provided herein (including the designation made as to ownership of property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and complete and that you may consider this statement as continuing to be true and correct until a written notice of change is given to you by the undersigned. You are authorized to make all inquiries you deem necessary to verify the accuracy of the statements made herein, and to determine my/our creditworthiness, including obtaining personal credit bureau reports. You are authorized to answer questions about your credit experience with me/us.

Notice: The State Laws against discrimination require that all creditors make credit equally available to all credit-worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The State Civil Rights Commission administers compliance with this law.

Signature D.O.B Co-Applicant Signature Co-Applicant D.O.B

By submitting this application, I/we authorize a consumer credit report and verify the statements in this application. Furthermore, I/we agree to be bound by the terms and conditions of the debit card, and the electronic funds transfer disclosure, copies of which will be mailed to the applicant if a card is granted. Receipt of terms and conditions, and disclosure, and acceptance of such terms will be conclusively presumed by use of the card. If this is a joint application, the undersigned shall be jointly and severally liable for any and all debit card transactions. Both parties must sign if a joint account is desired.