Pesonal Financial Statement
PERSONAL FINANCIAL STATEMENT
Statement of Financial Condition As Of ______/______/______
Applicant Name: Business Phone
Co-Applicant Name: Business Phone
Residence Address Residence Phone
City, State, & Zip
JOINT CREDIT APPLICATION
By submitting this Personal Financial Statement, we intend to apply for joint credit.
_______________________________ ______________________________
Applicant Signature Co-Applicant Signature
ASSETS
AMOUNT ($)
LIABILITIES & NET WORTH
AMOUNT ( $)
Cash in Bank
(including money market accounts, CDs)
Notes Payable to Bank
Secured
Cash in Other Financial Institutions (List)
(including money market accounts, CDs)
Unsecured
Notes Payable to Others
(Schedule F)
Secured
Unsecured
Credit Cards & Accounts Payable
Margin Accounts
Readily Marketable Securities
(Schedule A)
Notes Due to Privately Owned Businesses
Non-Readily Marketable Securities
(Schedule A)
Taxes Payable
Ownership in Privately Owned Businesses
(Schedule B)
Personal Residential Mortgages
(Schedule D)
Notes Receivable from Business Investment Real Estate Debt
(Schedule E)
Notes Receivable from Others Life Insurance Loans
(Schedule C)
Net Cash Surrender Value of Life Insurance
(Schedule C)
Other Liabilities (List):
Real Estate for Personal Use
(Schedule D)
Real Estate Investments
(Schedule E)
Retirement Accounts
(IRA, Keogh, Profit Sharing & Other)
Automobiles
Total Liabilities
Other Assets (List):
Net Worth
(Total Assets minus Total Liabilities)
Total Assets
Total Liabilities & Net Worth
SOURCES OF INCOME
CONTINGENT LIABILITIES
Salary As Guarantor, Endorser, or Co-maker
Bonus and Commissions On Leases or Contracts
Interest & Dividends Legal Claims
Real Estate Income Provisions for Federal Income Taxes
You need not disclose alimony, child support or separate maintenance inc
ome unless you wish the
Bank to consider them in a credit decision.
Other Special Debt
Other Income (please itemize)
Total Income Total Contingent Liabilities
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