PERSONAL FINANCIAL STATEMENT PERSONAL FINANCIAL STATEMENT AS

							                     PERSONAL FINANCIAL STATEMENT


PERSONAL FINANCIAL STATEMENT AS OF____________________

Name:__________________________                 Social Security No.___________________

Home Address:_________________________________________________________

Home Phone:__________________________________

Spouse:_________________________                Social Security No.___________________

              ASSETS                                            LIABILITIES
Cash on Hand_____________________ Loans Payable                          Monthly        Balance

Stocks and Bonds__________________                __________________________________

Loans Receivable__________________               __________________________________

Cash Value Insurance______________                __________________________________

Real Estate Owned_________________                Revolving Debt (credit cards etc.)

Autos/Boats Total Value____________               Company                 Monthly       Balance

Other____________________________                ___________________________________

      ____________________________               ___________________________________

      ____________________________               ___________________________________

Total monthly income______________               Total monthly expense________________

TOTAL ASSETS______________                       TOTAL LIABILITIES___________
                                                  NET WORTH__________________
_________________________________ _____________________________________
                 Name                             Date

 The information provided above is accurate as to the best of my knowledge. I understand that any
credit approval extended to me is contingent upon the accuracy of the information I have provided.