Personal financial statement

Personal Financial Statement TO:_______________________ The undersigned for the purpose of procuring and establishing credit from time to time with you and further, to induce you to permit the undersigned to become indebted to you on notes, endorsements, guarantees, overdrafts or otherwise, furnishes the following (or in lieu thereof the attached) which is the most recent statement prepared by or for the undersigned as being a full, true and correct statement of the financial condition of the undersigned on the date indicated, and agrees to notify you immediately of the extent and character of any material change in said financial condition, and also agrees that if the undersigned, or any endorser or guarantor of any of the obligations of the undersigned, at any time fails in business or becomes insolvent, or commits an act of bankruptcy, or dies, or if a writ of attachment, garnishment, execution or other legal process be issued against property of the undersigned or if any assessment for taxes against the undersigned, other than taxes on real property, is made by the federal or state government or any department thereof, or if any of the representations made below prove to be untrue, or if the undersigned fails to notify you of any material change as above agreed, or if such change occurs, or if the business, or any interest therein, of the undersigned is sold, then and in such case, all of the obligations of the undersigned to you or held by you shall immediately be due and payable, without demand or notice. This statement shall be construed by you to be a continuing statement of the condition of the undersigned, and a new and original statement of all assets and liabilities upon each and every transaction and by which the undersigned hereinafter becomes indebted to you, until the undersigned advises in writing to the contrary. ____________________ Date:_______________ (Signature)