Date:
Personal Financial Statement
Name:
Home Phone
Address:
Business Phone
Social Security Number:
Date of Birth:
Please do not leave any questions unanswered.
For the purpose of procuring and maintaining credit from time to time in any form whatsoever with Metairie Bank ("Bank"), for claims and demands against the
undersigned, the undersigned submits the following as being a true and accurate statement of the undersigned's financial condition on the following date , and agrees
that if any change occurs that materially reduces the means or ability of the undersigned to pay all claims or demands against it, the undersigned will immediately and
without delay notify the said Bank, and unless the Bank is so notified it may continue to rely upon the statement herein given as a true and accurate statement herein
given as of the close of business.
COMMUNITY
OWNED AND
APPLICANT'S
SEPARATE
ASSETS
SEPARATE
PROPERTY OF
SPOUSE
LIABILITIES
Cash and Equivalents
Listed Securities
U. S. Government Securities
CSV Life Insurance
Other Liquid Assets
Retirement Accounts
Unlisted Securities
Real Estate Owned
OF APPLICANT
OF SPOUSE
Notes Payable - Secured
Notes Payable - Unsecured
Interest Payable
R/E Mortgages - Residence
R/E Mortgages - Other
Accounts and bills due
Loans against CSV Life Insurance
Taxes payable - Current
Taxes payable on FMV write-up
Notes Payable to Relatives
Real Estate Partnership Interest
Notes Receivable
Automobiles
Personal Property
Other Assets:
Other Debts:
Total:
$0
(A)
SOURCES OF INCOME
(B)
$0
OF APPLICANT
AND SPOUSE (C + D)
$0
NET WORTH (A-E) DO NOT INCLUDE
SPOUSE'S SEPARATE PROPERTY (B)
$0
TOTAL LIAB. & NET WORTH (E+F)
$0
CONTINGENT LIABILITIES
OF SPOUSE
Salary
Bonus and Commissions
Dividends
Real Estate Income
$0
(D)
(E)
TOTAL LIABILITIES OF APPLICANT
TOTAL ASSETS
(C)
(F)
OF
(G)
APPLICANT
OF SPOUSE
(If Yes, complete sections below)
As Endorser or Co-maker
On Leases or Contracts
L ega l C l a i m s
Provisions for Income Taxes
Other Debts
Other Income: Notice:Alimony, child
support or separate maintenance income
need not be revealed if the Applicant or CoApplicant does not choose to have it
considered as a basis for repaying this
request.
Input additional info here if applicable:
TOTAL:
$0
$0
Has applicant executed a separate property agreement with spouse?
TOTAL:
$0
$0
Partner or Officer in Any Other Venture?
If "Yes", please attach a copy of the agreement
PERSONAL INFORMATION
Drivers License Number:
Business or Occupation
Email Adress:
LA:
NOTICE TO APPLICANT: You are not required to answer the questions in this section, unless: i) you reside in a community property state (such as Louisiana or
Texas); ii) your spouse is to be contractually liable along with you for repayment of the credit requested; or iii) your spouse is to be an authorized user on your credit
account with Bank.
Applicant's Marital Status
(If Applicant Resides in a Community Property State) Spouse's Name
Spouse's Address (If different from Applicant)
Spouse's Occupation
Spouse's Employer (Name & Address)
Spouse's Income
$
Driver's License Number:
GENERAL INFORMATION
Are any Assets Pledged?
Have you ever filed Bankruptcy? (Explain)
Are you a defendant in any suits or legal action?
Personal Bank Accounts with :
Social Security Number
SCHEDULE 1 - DEPOSITS (If you need additional space, please attach a separate schedule)
TYPE OF ACCOUNT
FINANCIAL INSTITUTION
PLEDGED
IN NAME OF
MATURITY
BALANCE
Total:
$0
SCHEDULE 2 - SECURITIES (Including U.S. Government Bonds & Notes, Municipals Bonds, Mutual Funds, Publicly Traded and closely held Stocks, Etc.)
NO. SHARES OR
PAR VALUE
PLEDGED
DESCRIPTION
YES
IN NAME OF
NO
MARKET VALUE
TOTAL:
$0
SCHEDULE 3 - REAL ESTATE (If you need additional space, please attach a separate schedule)
DESCRIPTION OF PROPERTY
IMPROVEMENTS
%
DATE OF
OWNED ACQUISITION
MARKET
VALUE
TITLE IN NAME OF
COST
TOTAL:
$0
MORTGAGE
Amount
$0
Maturity
Monthly
Payment MORTGAGEE OR LIENHOLDER
$0
$0
SCHEDULE 4 - LIFE INSURANCE (If you need additional space, please attach a separate schedule)
FACE AMOUNT
NAME OF COMPANY
BENEFICIARY
CASH SURRENDER VALUE
TOTAL:
LOANS
$0
SCHEDULE 5 - ACCOUNTS / OTHER DEBTS (List all other debts, including any debts or accounts in the name of your spouse which may be satisfied out of your income and/or property)
NAME OF CREDITOR
OR CREDIT LINE
BALANCE
PAYMENTS
$0
TOTAL:
Unsecured
ACCOUNT IS MAINTAINED
$0
THE UNDERSIGNED CERTIFIES THAT BOTH SIDES HEREOF AND THE INFORMATION INSERTED THEREIN HAS BEEN CAREFULLY READ AND IS TRUE AND CORRECT.
I agree to notify the Bank of any material change in the above statement.
I authorize the Bank to obtain such information as the Bank may require concerning the statements made in this application and agree that the application shall remain the Bank's property whether
or not the loan is granted. I, the above named applicant(s), further declare that the foregoing statement is true in every respect.
In making this application, I understand that an investigation may be made whereby information may be obtained through personal interviews with my neighbors, friends or others with whom I am
acquainted. This inquiry may include information as to my general character, reputation, personal characteristics and mode of living. I further understand that I have the right to make a written
request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation.
If you intend to apply for joint credit please initial here:
Date Signed
Applicant
Co-applicant
Signature
Signature
$0