Personal Financial Statement Page 2
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6For Creditor Use
Date Personal Financial Statement Received:
Completed Application Date:
Date Closing Rate Set:
PERSONAL FINANCIAL STATEMENT
Action Taken Date:
SECTION 1 - INDIVIDUAL INFORMATION
Name
Date of Birth:
Residence Address
City, State & Zip
Position or Occupation
Length of Time (Yrs):
Business Name
Business Address
City, State & Zip
Res. Phone
Cell Phone:
Bus. Phone:
Email Address
Monthly Payment:
Estimated Yearly Living Expenses:
Do You Own or Rent?
SECTION 2 - OTHER PARTY INFORMATION
Name
Date of Birth:
Residence Address
City, State & Zip
Position or Occupation
Length of Time (Yrs):
Business Name
Bus. Address
City, State & Zip
Res. Phone
Cell Phone:
Bus. Phone:
Email Address
Monthly Payment:
Estimated Yearly Living Expenses:
Do You Own or Rent?
SECTION 3 - JOINT INTENT
Applicant is applying for this loan:
Jointly (initial Below)
As a Guarantor
Individually
We intend to apply for joint credit (initials).
Co-applicant:
Applicant:
mm/dd/yy
SECTION 4 - STATEMENT OF FINANCIAL CONDITION AS OF:
ASSETS
In Dollars
Cash in Banks -
See Schedule A
$0
Stocks, Bonds and Closely Held Businesses -
See Schedule B - Attach Brokers Statement
$0
Non-Marketable Securities - Attach Brokers Statement
$0
Life Insurance (Cash Value) -
See Schedule C
$0
Accounts And Notes Receivable -
Schedule D
$0
Real Estate Owned Primary Residence -
See Schedule E
$0
Real Estate Owned - Investment -
See Schedule E
$0
Partial interest in Real Estate -
See Schedule E
$0
Automobiles -
See Schedule F
$0
Other Personal Property -
See Schedule F
$0
IRA/Roth IRA/Keogh Accounts (If Not Listed on Schedule B) - Attach Brokers Statement
$0
Profit Sharing/401K Plans/Pension Plan (If Not Listed on Schedule B) - Attach Brokers Statement
$0
Business Assets (If Not Listed Elsewhere)
$0
Other Assets - Attach Separate Itemized Sheet
$0
TOTAL ASSETS
$0
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