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Schedule 6

Notes payable to banks/others, Installment loans, Auto loans, Credit Cards, Lines of credit, Bills due

Name of Creditor/Lender/Party Owed

Collateral (if any)

Monthly payments

Balance Due

Explanation

Applicant

Co-Applicant

Applicant

Co-Applicant

Annual Income

Contingent Liabilities

Salary

As Endorser

Bonuses/Commisions

As Guarantor

Dividends/Interest

Lawsuits

Rental/Real Estate Income

Taxes

Other (list)

Alimony, child support, or maintenance need not be

entered unless you want to consider it

Other (list)

Total:

Applicant

Co-Applicant

Have you ever gone through bankruptcy?

Yes

Have you ever had a judgment against you?

Yes

Do you have any suits or legal action against you?

Yes

Are there any of your tax obligations past due?

Yes

Have you made a will?

Yes

Are you a co-maker, endorser or guarantor of any other person’s debt?

Yes

Explanation (if necessary):

This statement is given to you for the purpose of obtaining credit. It is true and correct in every detail and fairly shows my/our financial condition at this time.

I/we will give you prompt written notice of any substantial change in such financial condition occurring before full payment of my/our obligations to you. I/we

understand that you will keep this personal financial statement whether or not you approve the credit for which it is submitted. You are authorized to check

my/our credit and employment history or any other information provided.

THE UNDERSIGNED CERTIFY THAT THE INFORMATION CONTAINED ON THIS FORM HAS BEEN CAREFULLY

REVIEWED AND THAT IT IS TRUE AND CORRECT IN ALL RESPECTS

Date

Applicant Signature

Date

Co-Applicant Signature