Personal Financial Statement Form
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1
2PERSONAL FINANCIAL STATEMENT
OWNER/GUARANTOR
officer nAme:
brAnch:
phone #:
BUSINESS INFORMATION
K
K
CREDIT REQUEST
ApplicAnt only
joint with co-ApplicAnt(s)
business leGAl nAme:
WE INTEND TO APPLY FOR JOINT CREDIT:
ApplicAnt___________ co-ApplicAnt__________
DoinG business As (DbA) nAme, if Any:
PLEASE PROVIDE INFORMATION FOR ANYONE OWNING10% OR MORE OF THE BUSINESS. ATTACH ADDITIONAL SHEETS IF NECESSARY. WE WILL ACCEPT AN ACCOUNTANT
PREPARED PERSONAL FINANCIAL STATEMENT ATTACHED TO THIS FORM ALONG WITH A CUSTOMER SIGNATURE ACKNOWLEDGING THIS FORM AND DISCLOSURES.
OWNER/GUARANTOR #1
OWNER/GUARANTOR #2
nAme:
nAme:
K
K
SOLE PROPRIETORSHIP OR BUSINESS INDIVIDUAL:
owner
SOLE PROPRIETORSHIP OR BUSINESS INDIVIDUAL:
owner
K
K
K
K
PARTNERSHIP:
pArtner
limiteD pArtner
PARTNERSHIP:
pArtner
limiteD pArtner
K
K
K
K
OFFICER
OFFICER
LIMITED LIABILITY CO:
member
mAnAGer
LIMITED LIABILITY CO:
member
mAnAGer
TITLE
TITLE
K
K
K
K
K
K
CORP:
presiDent
Vice presiDent
corp. secretAry
CORP:
presiDent
Vice presiDent
corp. secretAry
K
K
other: _____________________________________________________
other: _____________________________________________________
K
K
K
K
VeterAn:
yes
no
VeterAn:
yes
no
DAte of birth:
DAte of birth:
sociAl security #:
sociAl security #:
home phone:
home phone:
street ADDress:
street ADDress:
city/stAte/zip:
city/stAte/zip:
DAte you moVeD to this ADDress:
DAte you moVeD to this ADDress:
monthly housinG expense
(principAl, interest, tAxes & insurAnce) or rent:
monthly housinG expense
(principAl, interest, tAxes & insurAnce) or rent:
$____________________________________________
$____________________________________________
K
K
K
K
own
rent
own
rent
totAl AnnuAl income*: $
totAl AnnuAl income*: $
employer:
DAte of hire:
employer:
DAte of hire:
position:
AnnuAl sAlAry:
position:
AnnuAl sAlAry:
present ownership since:
present ownership since:
% ownership of business:
% ownership of business:
____________month ____________yeAr
____________month ____________yeAr
K
K
K
K
K
K
K
K
u.s. citizen:
yes
no
leGAl permAnent resiDent Alien:
yes
no
u.s. citizen:
yes
no
leGAl permAnent resiDent Alien:
yes
no
checKinG bAlAnce: $
sAVinGs bAlAnce: $
checKinG bAlAnce: $
sAVinGs bAlAnce: $
presently bAnK At:
presently bAnK At:
*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.
PERSONAL FINANCIAL STATEMENT
ASSETS (whAt you own) As of:
LIABILITIES (whAt you owe) As of:
cAsh/checKinG/sAVinGs
$
Accounts AnD bills Due
$
creDit cArDs/reVolVinG loAns
stocKs AnD bonDs (see scheDule A)
$
$
(see scheDule D)
retirement Accounts
$
instAllments/other loAns
$
(see scheDule e)
reAl estAte (see scheDule b)
$
mortGAGes AnD home equity loAns
Automobiles
$
$
(see scheDule c)
TOTAL LIABILITIES
$
other Assets
$
estimAteD VAlue of business
$
NET WORTH
$
(totAl Assets minus totAl liAbilities)
TOTAL ASSETS
$
continGent liAbilities
$
continGent Assets
$
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