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Personal Financial Statement Form

  • You may apply for a credit extension, loan or other financial accommodation alone or together with someone else (“co-applicant”). This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-applicants if their assets and liabilities are sufficiently joined so that the statement can be meaningfully and fairly presented on a combined basis and you are applying jointly; otherwise separate statements and schedules are required.

    SBA Loan Applicants ONLY: If applying individually, your spouse must still complete the co-applicant section and include all spousal assets on the Personal Financial Statement. As a Federal Special Purpose Credit Program, the SBA requires this information for program eligibility purposes; however, this does not require you to become a borrower on this credit.

  • Applicant/Guarantor

  • NameAge 
  • Co-Applicant/Co-Signer/Co-Guarantor

  • NameAge 
  • Applicant Annual Income

    Please input numbers -- e.g. 3000 -- without dollar signs or shorthand indicators ("3k").
  • TypeAmount 
  • Co-Applicant Annual Income

    Please input numbers -- e.g. 3000 -- without dollar signs or shorthand indicators ("3k").
  • TypeAmount 
  • Contingent Liabilities Detail

  • To Whom PayableMaximum LiabilityCollateralPayment Terms: $___ per ____ 
  • Schedule 1

  • Name of Financial InstitutionType of AccountIn Whose Name?Account Balance 
  • Enter on line #1 in the summary as an ASSET.
  • Schedule 2

  • Financial InstitutionType of AccountIn Whose Name?Account Balance 
  • Enter on line #2 in the summary as an ASSET.
  • Schedule 3

  • No. shares or Bond amountDescriptionPledged?In Whose Name?CostCurrent Value 
  • Enter on line #3 in the summary as an ASSET.
  • Schedule 4

  • Insurance CompanyInsuredBeneficiaryFace Value of PolicyCash Value of PolicyLoan Amount Against Policy 
  • Enter on line #4 in the summary as an ASSET.
  • Enter on line #4 in the summary as a LIABILITY.
  • Schedule 5

  • AddressPurchase yearPurchase priceMarket ValueLender NameInterest RateMaturity DateMonthly PaymentLoan Balance 
  • Enter on line #5 in the summary as an ASSET.
  • Enter on line #5 in the summary as a LIABILITY.
  • Schedule 6

  • AddressPurchase yearPurchase pricePurchase %Market ValueLender NameInterest RateMonthly IncomeMonthly PaymentCurrent Balance 
  • Enter on line #6 in the summary as a LIABILITY.
  • Schedule 7

  • Name of DebtorDescription of PropertyMaturity DateRepayment Terms $___ per ___Maturity DateBalance Due 
  • Enter on line #7 in the summary as an ASSET.
  • Schedule 8

  • Lender NameType: Collateral or UnsecuredInterest RateMaturity DatePayment terms: $___ per ___Loan Balance 
  • Enter on line #8 in the summary as an ASSET.
  • Enter on line #8 in the summary as a LIABILITY.
  • Summary - Assets

    Complete from information on above schedules.
  • Year/Make/ModelAmount 
  • DescriptionAmount 
  • Summary - Liabilities

    Complete from information on above schedules.
  • DescriptionAmount 
  • Summary - TOTAL

  • Total assets minus total liabilities.
  • Applicant Questionnaire

  • Co-Applicant Questionnaire

  • Applicant Attestation

    This statement and all supporting schedules, submitted for the purpose of obtaining credit, is true and correct in every detail and fairly shows my/our financial condition at the time indicated. I/we will give you prompt written notice of any subsequent substantial change in such financial condition occurring before discharge of my/our obligations to you. I/we understand that you will retain this personal financial statement whether or not you approve the credit in connection with which it is submitted. You are authorized to check my/our credit and employment history or any other information contained herein.
  • MM slash DD slash YYYY
  • Co-Applicant Attestation

    This statement and all supporting schedules, submitted for the purpose of obtaining credit, is true and correct in every detail and fairly shows my/our financial condition at the time indicated. I/we will give you prompt written notice of any subsequent substantial change in such financial condition occurring before discharge of my/our obligations to you. I/we understand that you will retain this personal financial statement whether or not you approve the credit in connection with which it is submitted. You are authorized to check my/our credit and employment history or any other information contained herein.
  • MM slash DD slash YYYY
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Contact

5684 Bishop Ave
Inver Grove Heights, MN 55076
Phone: (651) 457-7539
Fax: (651) 457-2229
Toll Free: 1-888-995-7539

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