PERSONAL FINANCIAL STATEMENT 
                                                                                                                        AS OF:
                                                                                                                                           mm/dd/yyyy
                                  Individual 1:                                                           If Joint Statement:
                                      Address:                                                                          Individual 2:
                                City/State/Zip:                                                             Social Security Number:                         Birth Date:
                     Home/Work/Cell Phone:                                                                 Home/Work/Cell Phone:                                             mm/dd/yyyy
                                Email Address:                                                                        Email address:
                      Social Security Number:                        Birth Date:                       Relationship to Individual 1:
                                                                                      mm/dd/yyyy
                                                                                                                              SOLELY OWNED                  JOINTLY           TOTAL
                                                           ASSETS                                                                                           OWNED
                                                                                                                      INDIVIDUAL 1      INDIVIDUAL 2
             Cash (Include CD's, Money Market Accounts) (Schedule 1)                                                 $                           -     $                           -     $                           -     $                           -   
             Government & Readily Marketable Securities (Schedule 2)                                                                                                      $                           -   
             Non-Marketable Securities (Schedule 3)                                                                                                                       $                           -   
             Cash Value of Life Insurance (Schedule 5)                                                                                                                    $                           -   
             Personal Residence(s) (Schedule 6)                                                                                                                           $                           -   
             Personal Property                                                                                                                                            $                           -   
             IRA's Keoghs and other Qualified Retirement Funds (Schedule 2)                                                                                               $                           -   
             Other Assets (describe)                                                                                                                                      $                           -   
                                                                                                    TOTAL ASSETS     $                           -     $                           -     $                           -     $                           -   
                                                                                                                               SOLELY LIABLE                JOINTLY           TOTAL
                                                 LIABILITIES & NET WORTH                                                                                    LIABLE
                                                                                                                      INDIVIDUAL 1      INDIVIDUAL 2
             Notes Payable To Banks - Secured (Schedule 7)                                                           $                           -     $                           -     $                           -     $                           -   
             Notes Payable To Banks - Unsecured (Schedule 7)                                                                                                              $                           -   
             Notes Payable to Others - Secured (Schedule 7)                                                                                                               $                           -   
             Notes Payable to Others - Unsecured (Schedule 7)                                                                                                             $                           -   
             Margin Accounts (Schedule 2)                                                                                                                                 $                           -   
             Accounts Payable (Include Credit Cards) (Schedule 7)                                                                                                         $                           -   
             Real Estate Mortgages Payable (Schedule 6)                                                                                                                   $                           -   
             Taxes Payable (Describe)                                                                                                                                     $                           -   
                                                                                                                                                                          $                           -   
                                                                                                                                                                          $                           -   
             Loans on Life Insurance Polices (Schedule 5)                                                                                                                 $                           -   
             Other Liabilities (List)                                                                                                                                     $                           -   
                                                                                                                                                                          $                           -   
                                                                                                                                                                          $                           -   
                                                                                               TOTAL LIABILITIES     $                           -     $                           -     $                           -     $                           -   
                                                       NET WORTH (Subtract Total Liabilities from Total Assets)  $                      -     $                      -     $                      -     $                      -   
                                            CONTINGENT LIABILITIES / DETAILS                                          INDIVIDUAL 1      INDIVIDUAL 2         JOINT            TOTAL
             As Guarantor or Endorser                                                                                                                                     $                           -   
             On Leases or Contracts                                                                                                                                       $                           -   
             For Legal Claims or Judgments                                                                                                                                $                           -   
             Tax Claims or Disputes                                                                                                                                       $                           -   
             Letter of Credit                                                                                                                                             $                           -   
             Other                                                                                                                                                        $                           -   
                                                                                                                                                                          $                           -   
                                                                                TOTAL CONTINGENT LIABILITIES     $                           -     $                           -     $                           -     $                           -   
                                                                              CASH INCOME & EXPENSE STATEMENT
                                                                                 FOR THE YEAR ENDED:
                                                                                                                         mm/dd/yyyy
                                         SOURCES                                   INDIVIDUAL 1      INDIVIDUAL 2              SOURCES                   INDIVIDUAL 1      INDIVIDUAL 2
             Wages and Salaries                                                                                     Mortgage / Rent Payments
             Bonuses, Commissions, Etc.                                                                             All Other Debt Service
             Interest & Dividends                                                                                   Alimony / Child Support
             Rental Income (Net)                                                                                    Tuition
             Partnership Distributions                                                                              Insurance
             Other (List)                                                                                           Living Expenses
                                                               TOTAL INCOME     $                           -     $                           -         $                           -     $                           -   
                                                   If the space provided is not sufficient additional schedules may be attached.
                          To indicate ownership in each schedule, select 1, 2, or J in the appropriate space to indicate individual 1, Individual 2, or Joint, respectively.
                                                           SCHEDULE 1 - CASH (Includes CD's, Money Markets)
                NAME OF INSTITUTION       OWNED BY                                      ACCOUNT TYPE AND NUMBER                  BALANCE       PLEDGED
                                          1   2    J                                                                                            YES / NO
                                                  SCHEDULE 2 - GOVERNMENT AND READILY MARKETABLE SECURITIES
             FACE VALUE OR # OF SHARES    OWNED BY                          DESCRIPTION                             COST         CURRENT       AMOUNT
                                          1   2    J                                                                          MARKET VALUE     PLEDGED
                                                             SCHEDULE 3 - NON-MARKETABLE SECURITIES
             NUMBER OF SHARES OWNED       OWNED BY                                  DESCRIPTION                                   VALUE        AMOUNT
                                          1   2    J                                                                                           PLEDGED
            
                                                          SCHEDULE 4 - NOTES AND ACCOUNTS RECEIVABLE
                     DUE FROM             OWNED BY      ORIGINAL       CURRENT       SECURED              COLLATERAL             PAYMENT         TERM
                                          1   2    J    AMOUNT         BALANCE        YES / NO
                                                                    SCHEDULE 5 - LIFE INSURANCE
                INSURANCE COMPANY         OWNED BY                    BENEFICIARY                     FACE          CASH          POLICY        AMOUNT
                                          1   2    J                                                 VALUE          VALUE         LOANS         PLEDGED
                                        SCHEDULE 6 - REAL ESTATE (If partially owned, give total property information, not just share)
               DESCRIPTION & LOCATION     OWNED BY          %            DATE          COST          VALUE        MORTGAGE       MONTHLY       NET YEARLY
                                          1   2    J                   ACQUIRED                                    BALANCE       PAYMENT       CASH FLOW
                                     SCHEDULE 7 - NOTES PAYABLE AND ACCOUNTS PAYABLE (Exclude amounts reported in Schedule 6)
                      DUE TO              OWNED BY       ORIGINAL      CURRENT      REMAINING NO. OF PAYMENTS /                 COLLATERAL
                                          1   2    J     AMOUNT        BALANCE               AMOUNT
                                                                REPRESENTATIONS AND WARRANTIES
           For the purpose of procuring credit from time to time, I/We furnish the foregoing as a true and accurate statement of my/our financial condition. Lender is hereby authorized to make all inquiries 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 reporting agency, including consumer 
           reporting agencies, to give you any information it may have on the undersigned. The undersigned also agrees to notify the Lender immediately in writing of any significant adverse change in such financial 
                                                                               condition.
                                                         Signature                                                 Signature
                                                           Date                                                      Date