Are you indirectly liable for obligations of others? If so, list and
describe. Please attach an additional sheet of paper if you need
more space.
Name:
Amount:
Description:
Name:
Amount:
Description:
Total amount as endorser, co-maker or guarantor $
Total amount on leases or contracts
$_____________________
FOR YEAR ENDED:
(A copy of your most recent Income Tax Return may be
requested)
Number of Dependents: Ages:
Are you obligated to pay alimony, child support or separate
maintenance payments? Yes No If yes, provide details:
Are you a defendant in any lawsuits or legal actions? If so, provide
details:
Have you ever declared bankruptcy or had any judgments
recorded against you? If so, provide details:
Date: City: County:
State:
Amount:
Description:
OTHER INCOME: (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)
Do you have a will? Yes No If yes, who is the executor?
Do you have disability insurance?
If so, what is the monthly amount?
What years are covered?
REPRESENTATIONS AND WARRANTIES
The information contained in this statement is provided to induce Bank of Oak Ridge to extend or to continue the extension of credit to the undersigned or to
others upon the guaranty of the undersigned. The undersigned acknowledge and understand that Bank of Oak Ridge is relying on the information provided
herein in deciding to grant or continue credit or to accept a guaranty thereof. Each of the undersigned represents, warrants and certified that the information
provided herein is true, correct and complete. Each of the undersigned agrees to notify Bank of Oak Ridge immediately and in writing of any change in
name, address, or employment and of any material adverse change: (1) in any of the information contained in this statement, or (2) in the financial condition
of any of the undersigned, or (3) in the ability of any of the undersigned to perform its obligations to Bank of Oak Ridge. In the absence of such notice or a
new full written statement, this should be considered as a continuing statement and substantially correct. If the undersigned fail to notify Bank of Oak Ridge
as required above, or if any information herein should prove to be inaccurate or incomplete in any material respect, Bank of Oak Ridge may declare the
indebtedness of the undersigned or the indebtedness guaranteed by the undersigned, as the case may be, immediately due and payable, Bank of Oak
Ridge is authorized to make all inquiries it deems necessary to verify the accuracy of the information contained herein and to determine the creditworthiness
of the undersigned. The undersigned authorize any person or consumer-reporting agency to give Bank of Oak Ridge any information they may have on the
undersigned. Each of the undersigned authorizes Bank of Oak Ridge to answer questions about Bank of Oak Ridge’s credit experience with the
undersigned. As long as any obligation or guaranty of the undersigned to Bank of Oak Ridge 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 give Bank of Oak Ridge
shall be Bank of Oak Ridge’s property.
THE UNDERSIGNED HAVE READ AND FULLY UNDERSTAND THE FOREGOING REPRESENTATION AND WARRANTIES.
DATE: YOUR SIGNATURE:
DATE: JOINT SIGNATURE (if joint financial statement):
Bank use only:
This statement rec’d by:
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