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)