Information provided below will be transmitted via a secure socket layer connection.

If you would like to request a personal financial statement, please provide the information requested. When you are done please click on the submit button. If you do not have the information to complete a particular part of this application you may leave it blank. Items with an asterisk (*) next to them are required.

Personal Financial Statement
 Name *
Date of Birth *
Social Security Number *
 Street Address *
City *
State *
Zip Code *
 Home Phone# *
Own Home     Renting
Buying Home Other
    Mortgage or Rent *
    
# of Dependants *
 Name of Employer
Title/Position
Length of Employment
Business Phone #
 Employer Street Address
City
State
Zip Code

 Name of Spouse
Date of Birth
Social Security Number
# of Dependants
 Name of Employer
Title/Position
Length of Employment
Business Phone #
 Employer Street Address
City
State
Zip Code
If married, you may apply for a separate account.  If you are married, complete all information for yourself and your spouse.  You do not have to list spouse's separate property unless this is an application for a joint account.  Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.


List of Assets Amount List of Liabilities Amount Owed Monthly Payment
 Cash in -Bank Name- Bank
 
 Income Taxes Payable
 Cash in other institutions
 
 Other Taxes Payable
 
 
 Charge Cards Payable
 (Schedule 4)
 
 
 Installment Loans
 
 
 Loans on Life Insurance
 Stocks & Bonds Owned (Schedule1)
 
 Loans on Stocks & Bonds
 IRA / Keogh / Pension Amounts
 
 
 Accounts / Notes Receivable (Schedule 2)
 
 
 Deeds of Trusts Owned
 (If not included in the amount above)
 
 Real Estate Market Value (s) (Schedule 3)
 
 Real Estate Indebtedness
 (Schedule 3)
 Other Investments / Partnerships
 
 Other Liabilities
 Automobiles:
 
 
 
 
 Total Payments  
 Personal Property
 
 Total Liabilities  
 Other Assets
 
 Net Worth
 (Assets-Liabilities)
 Total Assets  Total Liabilities
 + Net Worth


Annual Income Amount Annual Expenses Amount Contingent Liabilities Amount
 Applicant Salary  Interest Expense  As an Endorser
 Spouse's Salary  Property Taxes  As a Guarantor
 Dividend / Bond Income  Income & Other Taxes  As a Co-signer
 Interest Income  Mortgage Payments/Rent  On Damage Claims
 Rental Income  Credit Card Payments  Letters of Credit
 Other (Detail)  Loan Payments  Other (Detail)
   Insurance  
   Alimony, Child Support  
   Other (Detail)  
     

 Total Income:

 Total Expenses:

 Total Liabilities:



 General Information - If you are married, these questions apply to both you and your spouse.
 Are any assets held  in Trust? Yes   No
 Are any assets pledged or debts secured except as shown? Yes   No
 Have you ever had a repossession? Yes   No
 Have you ever had a bankruptcy or had a judgment against you? Yes   No
 Have you ever been a principle or guarantor of a firm that declared bankruptcy? Yes   No
 Are you a party to any claim or law suit? Yes   No
 Has there been an IRS audit in the past 3 years? Yes   No
 If yes, has the audit been settled? Yes   No
 If yes to any of the above, please explain. Yes   No


 Schedule 1: Marketable Securities:
 Are any of your Securities Restricted?
Yes No
Do you own 10% or more of the outstanding stock of any company?         
Yes No          
How Held # of Shares or Bond Amount Description Title In Name Of Pledged Present Market Value
  Indicate: [J] for jointly held with spouse     [O] for jointly held with other than spouse 
[A] for applicant's separate property  [S] spouse's separate property
Total $  


 Schedule 2: Notes Receivable - Mortgage & Deed of Trust Owned
How Held Name of Debtor Collateral Date of Note Monthly Payment Maturity Date Unpaid Balance
  Indicate: [J] for jointly held with spouse     [O] for jointly held with other than spouse 
[A] for applicant's separate property  [S] spouse's separate property
Total $ 


 Schedule 3: Real Estate Holdings - Mortgages or Liens
 Indicate Type:  [SD] for Single Dwelling  [MD] for Multiple Dwelling or  [C] for Commercial/Industrial

 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purc.
 % Owned
 Balance
 Monthly Pmt.
 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
 Property Address
How Held
Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
Property Address
How Held
 Type
 Name of Lender
 Market Value
 Original Cost
 Date Purch.
 % Owned
 Balance
 Monthly Pmt.
Indicate:  [J] for joint with spouse  [O] for jointly held with other than spouse
[A] for applicant's separate property   [S] for spouse's separate property
Total Owed
Total Pmts


 Schedule 4: Credit Cards And Loans Payable
                    Name of Creditor       Monthly Payment         Current Balance
     
     
     
     
     
     
     
     
     
     
     
     
Totals     $
                      $  

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize First National Bank Weatherford to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize First National Bank Weatherford to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I agree to provide any further information the Bank might require to process my application.


Applicant's Signature *

Date *

Spouse's Signature
(only if applying for joint credit)

Date