Full Legal Name / Citizenship / Date Birth / SSN or Tax ID#
Residence Street / Residence City / ST & Zip
How long at current residence?:
Value of residence(if owned): / $
Total of all debts secured by your Residence: / $
Marital Status:
If you are married:
Are any significant assets on this statement owned jointly with your spouse?
Will your spouse be a co-guarantor on this loan? / YES NO
YES NO
Ages of all dependents:
OCCUPATION
Primary Occupation/Job Title
Employer Name
How Long on this Job
How Long in this line of work
Income last year from this work:
Expected income this year from this work:
DEBTS AND ASSETS
TOTAL non-real estate secured debts owed personally
(Not by your businesses) / $
TOTAL real estate secured debts owed personally
(excluding your residence) / $
TOTAL market value of real estate owned personally
(Not by your businesses)
(exclude your residence value) / $
TOTAL real estate secured debt guaranteed for other entities/businesses / $
TOTAL market value of real estate owned by businesses/entities for which you guaranty debt / $
TOTAL CASH on hand in banks / $
TOTAL in non-retirement publically traded investments
(stock/brokerage accounts) / $
TOTAL margin debt if applicable / $
DESCRIBE CREDIT IN GENERAL AND ANY CREDIT ISSUES
within past 3 years.

CUSTOMER DISCLOSURE, CERTIFICATION, AND ACKNOWLEDGEMENT

Please check any box that is applicable to you. We understand there may be issues and have provided an area for comments below.

HAVE YOU OR ANY ENTITIES YOU HAVE OWNED >20% OF EVER:

Declared Bankruptcy
Had Property Foreclosed
Given Deed in Lieu of Foreclosure
Had a Short Sale
Have any outstanding Judgments >$1000
Have any Federal Taxes that are delinquent or in dispute
Have any lawsuits in process or threatened
Have been convicted of a Felony
NONE OF THE ABOVE ARE APPLICABLE TO ME OR ANY ENTITIES I OWN OR HAVE OWNED >20% OF
DISCLOSURE EXPLANATIONS/COMMENTS
CREDIT AUTHORIZATION

You are authorized to make order a personal credit report and conduct all inquiries you deem necessary to verify the accuracy of the information contained herein and to determine the credit worthiness of the undersigned. The undersigned authorizes any person or consumer reporting agency to give you any information it may have on the undersigned. Each of the undersigned authorizes all third parties to answer questions about their credit experience with the undersigned. As long as any obligation or guarantee of the undersigned to you is outstanding, the undersigned shall supply annually an updated financial statement. This personal financial statement and any other financial or other information that the undersigned gives you shall be your property.

CONSENT TO RECEIPT OF DISCLOSURES ELECTRONICALLY

I certify that I am able to receive emails with pdf attachments and open and print the documents. I consent to receive legal and all other documents related to this transaction in electronic form. I understand I may withdraw this consent at anytime. I may receive any of the documents provided in paper form as well upon my request. To withdraw my consent, or request a document in paper form, or change the email address at which I prefer to receive documents, I may contact my loan officer and verbally request any changes.

A U T H O R I Z A T I O N A N D A C K N O W L E D G E M E N T

This information and the information provided on all accompanying financial statements and schedules is provided for the purpose of obtaining credit for the Individual or the purpose of Individual guaranteeing credit for others. The Individual acknowledges that representations made in this statement will be relied on by the creditor in its decision to grant such credit. The Individual declares this statement is true and correct in every detail and accurately represents the condition of the Individual on the date given below. Individual authorizes Creditor to make all inquiries and order all credit and other reports deemed necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the undersigned. Individual authorizes Creditor to release any information obtained in this application or as part of the application process to third parties for purposes of ascertaining creditworthiness of the Applicant or Individual and/or marketability of the credit. Creditor is further authorized to answer any questions about Creditor's credit experience with Individual. Individual will promptly notify creditor of any subsequent changes, which would affect the accuracy of this statement. Individual is aware that any knowing or willful false statements made herein for purposes of influencing the actions of the Creditor can be a violation of federal law 18 U.S.C. sec. 1014 and may result in a fine or imprisonment or both. By signing below, each Individual declares that he/she has read and understandsthe statement above. In addition, each individual signing below authorizes the Creditor to check their individual credit account, employment history, have a credit reporting agency prepare a credit report on them, and make any other inquiries necessary for purposes of determining creditworthiness of applicant.

Signature / Printed Name / Date

PLEASE ATTACH

  1. Resume/Bio
  1. List/spreadsheet of past projects covering 24-36 months.
  1. Copy of your identification document.

THANK YOU