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PERSONAL_FINANCIAL_STATEMENT_BLANK_FORM

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					                                     PERSONAL FINANCIAL STATEMENT
NAME                                     AGE      SOCIAL SECURITY NO.

HOME ADDRESS                                                                                   YRS. THERE

CITY                             STATE                     ZIP CODE           HOME PHONE
                                                                              (  )
EMPLOYER                                                                      WORK PHONE
                                                                              (  )
EMPLOYER ADDRESS                                       CITY                        STATE           ZIP CODE

POSITION                                                      YRS. THERE             SOCIAL SECURITY NO.

SPOUSE NAME                                                        AGE
HOME ADDRESS                                                                                YEARS THERE

CITY                             STATE                     ZIP CODE           HOME PHONE
                                                                              (  )
EMPLOYER                                                                      WORK PHONE
                                                                              (  )
EMPLOYER ADDRESS                                       CITY                        STATE           ZIP CODE

POSITION                                                      YRS. THERE



                            YOU MAY APPLY FOR CREDIT EXTENSION OR
                       FINANCIAL ACCOMMODATION SEPARATELY OR JOINTLY

 Are you requesting this financial accommodation:             Separately?
                                                              Jointly with your spouse?
                                                              Jointly with another person: (Please submit
                                                               separate financial statements attached together.)



 Marital Status (answer only if this financial statement      Married
 is provided in connection with a request for secured         Separated
 Credit or if you live in a community property state,         Unmarried (unmarried includes
 such as California.                                             single, divorced, widowed)



 Reflect in this statement the financial condition of your spouse as well as your own financial condition if:

 1.      You are seeking this financial accommodation jointly with your spouse, or

 2.      You are relying on your spouse’s assets or income in requesting this financial accommodation, or

 3.      You live in a community property state like California




                                                                                                           Page 1 of 5
DATE OF STATEMENT____________, 20_____                                            *Please attach a separate sheet if you need
                                                                                   more space to complete a detail schedule.
                       ASSETS                          AMOUNT                     LIABILITIES                         AMOUNT
Cash in Heritage Bank of Commerce                               Notes Payable to Heritage Bank of Commerce
Cash in Other Banks (Detail)
                                                                Accounts Payable



Accounts Receivable                                             Notes Payable to Others (Schedule 7)

Notes Receivable (Schedule 1)                                   Income Taxes Payable
Mortgages & Deeds of Trust Owned (Schedule 2)                   Other Taxes Payable
Securities Owned (Schedule 3)
Cash Surrender Value of Life Insurance (Schedule 4)             Loans on Life Insurance (Schedule 4)
Real Estate (Schedule 5)                                        Mortgages or Liens on Real Estate (Schedule 6)
Automobiles                                                     Installment Contracts Payable
                                                                Credit and Charge Cards
Personal Property
IRA Account                                                     Other Liabilities (Detail)
Other Assets (Detail)



                                                                                             TOTAL LIABILITIES
                                                                                                 NET WORTH
                                        TOTAL                                                        TOTAL




  ANNUAL INCOME                                       ANNUAL EXPENDITURES                  CONTINGENT LIABILITIES
Employment Income                                Property Taxes                         As Endorser
                                                 Income Taxes                           As Guarantor
Dividends                                        Mortgage P & I                         On Damage Claims
Interest                                         Contract Payments                      For Taxes
Rentals (Schedule 5)                             Insurance                              Other (Detail)
Alimony Child support                            Living Expense
Other                                            Alimony, Child support
                                                 Other



                      Total                  =                Total                                       Total
                    Income                             Expenditures                                 Contingent
                                                                                                     Liabilities


SCHEDULE 1 NOTES RECEIVABLE
  NAME OF DEBTOR  COLLATERAL                                 PAYABLE                  MAURITY               TOTAL
                                                                                       DATE               AMOUNT DUE
                                                         $               per
                                                         $               per
                                                         $               per



                                                                                                                    Page 2 of 5
                                                               TOTAL



SCHEDULE 2 MORTGAGES AND DEEDS OF TRUST OWNED
  NAME OF      LIEN   PROPERTY  PRIOR     HOW MATURITY UNPAID
   DEBTOR    POSITION   VALUE   LIENS PAYABLE   DATE  BALANCE
                                       $
                                       per
                                       $
                                       per
                                       $
                                       per



SCHEDULE 3 SECURITIES OWNED
                   EXCHANGE                                                          TOTAL      PLEDGE
                                                                                                   D?
 NO. SHARES OR   N=NYSE A=AMEX                                  HOW    PRICE PER    MARKET       Y=YES
                                                                HELD
 BOND AMOUNT        O=OTC        DESCRIPTION   TITLE IN NAME    CODE    SHARE        VALUE        N=NO
                  L=UNLISTED                         OF




                                                                       TOTAL

SCHEDULE 4 LIFE INSURANCE
 INSURED    FACE AMOUNT OF               INSURANCE         BENEFICIARY             CASH        LOANS
                  POLICY                  COMPANY                                  VALUE



                                                                       TOTAL




                                                                                             Page 3 of 5
SCHEDULE 5 REAL ESTATE
                                          HOW       COST       MONTHLY PRESENT                  TOTAL
                                          HELD                                                 BALANCE
                                                                                                OWED
ADDRESS AND TYPE          TITLE IN       CODE*      YEAR        INCOME        MARKET          (DETAIL IN
  OF PROPERTY             NAME OF                 ACQUIRE                      VALUE          SCHED. 6)
                                                      D
1-                                                $
                                                  YEAR

2-                                                $
                                                  YEAR

3-                                                $
                                                  YEAR

4-                                                $
                                                  YEAR


                                         TOTAL


SCHEDULE 6 MORTGAGES AND LIENS ON REAL ESTATE
       PROPERTY         INDICATE 1ST OR                                        INTEREST
 NO.   TO WHOM PAYABLE 2ND           HOW PAYABLE                            RATE   MAURITY                BALANCE
                        MORTGAGE                                                     DATE                  OWING
                                   $          Per
                                   $          Per
                                   $          Per
                                   $          Per
                                   $          Per
                                   $          Per
                                   $          Per


SCHEDULE 7 NOTES PAYABLE
    TO WHOM            ADDRESS                        COLLATERAL           INTEREST             UNPAID
                                                                             RATE              BALANCE




 HOW HELD    COMMUNITY PROPERTY                   SEPARATE PROPERTY (indicates applicable abbreviation)
     CODES   ALWAYS INDICATE "CP"   "SO" = SINGLE OWNERSHIP   "JT" = JOINT TENANTS      "TIC" = TENANTS IN COMMON




                                                                                                      Page 4 of 5
___________________________________________________________________
Yes         No
                Have you filed Bankruptcy?
                  If yes, which chapter?          7             11            13
                  Filing Date: __________/_____________/___________
                  Discharge Date: ________/_____________/___________
                  If not, why?______________________________________
                Have you:         Comprised a debt?
                Had a suit or judgment entered against you?
                Had a vehicle repossessed?
                If this is a statement of you and your spouse, are any assets your
                  spouse’s separate property?

                         What assets are held in Joint tenancy?




                       Are any of your assets held in trust?

           CREDIT REFERENCE                          NEAREST RELATIVE NOT LIVING WITH
                                                                   YOU
Name:                                              Name:

Address:                                           Address:

Phone:                                             Phone:

Name:                                              Name:

Address:                                           Address:

Phone:                                             Phone:


The information on the pages of this form is submitted for the purpose of inducing Lender to extend credit and is a
true, full and correct statement of my/our financial condition as of the date shown. I/we acknowledge and agree
that the Lender will rely upon the information provided on this form and that intentionally false, incomplete or
incorrect information may constitute fraud. While indebted to you, I/we agree to notify you immediately of any
material change of my/our financial condition. In the event that such notification is not given, or if other acts occur
that, in your opinion, either do or could adversely affect the Lender’s interest, then any and all outstanding
obligations may, at your election, become due and payable without demand or notice and may be charged against
any and all assets of the undersigned in possession or control of the Lender.

I authorize the Lender to check my credit references. I also authorize the Lender to provide credit information
arising from this transaction to others as may be reasonably requested.

 Applicant’s Signature               Date          Co-Applicant’s Signature               Date
                                                   (Where Applicable)


                                                                                                             Page 5 of 5

				
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