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 | PERSONAL FINANCIAL STATEMENT
 | IMPORTANT: Please read these directions before completing this Statement.
 | - If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections 1 & 3 and associated Schedules on Page 2. - If you are applying for joint credit with another person, complete all Sections providing information about the joint applicant in Section 2. - If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as a basis for repayment of the credit requested, complete all Sections, providing information in Section 2 about the person whose alimony, support, or maintenance payments or income or assets you are relying. - If this statement relates to your guaranty of the indebtedness of other person(s), firm(s), or corporation(s), complete Sections 1 & 3.
 |  | We intend to apply for joint credit. |  |  |  |  |  |  |  |  |  |  |  |  |  | Applicant: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Co-Applicant:
 |  |  |  |  |  |  | TO: | Collegiate Peaks Bank |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PHONE: | [PHONE]
 |  |  |  |  |  |  |  | 885 South Colorado Boulevard |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | FAX: | [PHONE]
 |  |  |  |  |  |  |  | Denver, Colorado  80246 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | WEB: | www.collegiatepeaksbank.com
 | SECTION 1 - APPLICANT INFORMATION (type or print) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] (type or print)
 | Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Name
 | Residence Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Residence Address
 | City, State, Zip |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | City, State, Zip
 | Personal Phone |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Personal Phone
 | Position or Occupation |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Position or Occupation
 | Business Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Business Name
 | Business Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Business Address
 | City, State, Zip |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | City, State, Zip
 | Business Phone |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Business Phone
 | SECTION 3 - STATEMENT OF FINANCIAL CONDITION
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | AS OF:
 | ASSETS |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | In Dollars |  |  |  |  |  | LIABILITIES |  |  |  |  |  |  |  |  |  |  |  | In Dollars |  |  |  |  |  | Monthly
 | (do not include assets of doubtful value) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (omit cents) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (omit cents) |  |  |  |  |  | Payment
 | Cash on Hand and in Banks |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Credit Cards
 | U.S. Government & Marketable Securities - Schedule A |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Lines of Credit
 | Retirement Accounts - Schedule B |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Notes Payable - Other
 | Non-Marketable Securities - Schedule C |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Real Estate Mortgages Payable - Schedule E
 | Partial Interest in Real Estate Equities - Schedule D |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Home Equity Loans
 | Real Estate Owned - Schedule E |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Automobile Loans
 | Loans Receivable |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Student Loans
 | Automobiles & Other Personal Property |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Unpaid Taxes and Interest
 | Cash Value Life Insurance - Schedule F |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other Debts - Itemize
 | Other Assets - Itemize
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL LIABILITIES |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NET WORTH |  |  |  |  |  |  |  |  |  |  |  | 0
 | TOTAL ASSETS |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0 |  |  |  |  |  | TOTAL LIABILITIES AND NET WORTH |  |  |  |  |  |  |  |  |  |  |  | 0
 | SOURCES OF INCOME |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PERSONAL INFORMATION
 |  |  |  |  |  |  |  |  |  |  | FOR THE YEAR ENDED:
 | Salary, Bonuses, Commissions |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Do you have a will?  Who is the executor?
 | Dividends
 | Real Estate Income |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Are you a partner or officer in any other venture?  Describe.
 | 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) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Are you obligated to pay alimony, child support, or separate maintenance?  Describe.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Income tax settled through (date):
 | TOTAL |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 | CONTINGENT LIABILITIES (add schedule, if needed) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Are you a defendant in any suits or legal actions?  Describe.
 | As Endorser, Co-Maker, or [NAME]?
 | On Lease or Contracts? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Personal bank accounts carried at:
 | Legal Claims
 | Other Special Debt |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Are any assets pledged other than as described on schedules?  Describe.
 | Amount of Contested Income Tax Liens
 | Do you have other contingent liabilities?  Describe. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Have you been declared bankrupt in the last 14 years?  When and where?
 | [NAME] AND SIGN ON PAGE TWO
 | SCHEDULE A - U.S. GOVERNMENT & MARKETABLE SECURITIES
 | Description |  |  |  |  |  |  |  |  |  |  |  |  | Number of Shares or Face Value (bonds) |  |  |  |  |  | In Name Of |  |  |  |  |  |  |  |  |  | Are These Pledged? |  |  |  |  |  |  |  | Market Value
 | SCHEDULE B - RETIREMENT ACCOUNTS
 | Description |  |  |  |  |  |  |  |  |  |  |  |  | Number of Shares or Face Value (bonds) |  |  |  |  |  | In Name Of |  |  |  |  |  |  |  |  |  | Are These Pledged? |  |  |  |  |  |  |  | Market Value
 | SCHEDULE C - NON-MARKETABLE SECURITIES
 | Description |  |  |  |  |  |  |  |  |  |  |  |  | Number of Shares or Face Value (bonds) |  |  |  |  |  | In Name Of |  |  |  |  |  |  |  |  |  | Source of Value |  |  |  |  |  | Are These Pledged? |  |  | Market Value
 | SCHEDULE D - PARTIAL INTERESTS IN REAL ESTATE EQUITIES
 | Address |  |  |  |  |  |  |  |  |  | Title In Name Of |  |  |  |  |  |  | % Owned |  |  | Date Acquired |  |  |  | Cost |  |  |  | Market Value |  |  |  | Mortgage Amount |  |  |  | Monthly Payment |  |  |  | Mortgage Maturity
 | SCHEDULE E - REAL ESTATE OWNED
 | Address |  |  |  |  |  |  |  |  |  |  | Title In Name Of |  |  |  |  |  |  |  |  | Date Acquired |  |  |  | Cost |  |  |  | Market Value |  |  |  | Mortgage Amount |  |  |  | Monthly Payment |  |  |  | Mortgage Maturity
 | SCHEDULE F - LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCE
 | Name of Insurance Company |  |  |  |  |  |  |  |  | Owner of Policy |  |  |  |  |  |  |  |  | Beneficiary |  |  |  |  |  |  |  |  | Face Amount |  |  |  |  | Policy Loans |  |  |  |  | Cash Surrender Value
 | SCHEDULE G - BANKS OR FINANCE COMPANIES WHERE CREDIT HAS BEEN OBTAINED
 | Name & Address of Lender |  |  |  |  |  |  |  |  |  |  |  |  |  | Credit in the Name Of |  |  |  |  |  |  |  |  | Secured or Unsecured? |  |  |  |  | Date Obtained |  |  |  | High Credit |  |  |  | Current Balance |  |  |  | Monthly Payment
 | The information contained in this statement is provided for the purpose of obtaining or maintaining credit with Collegiate Peaks Bank on behalf of the undersigned, or persons, firms, or corporations in whose behalf the undersigned may either severally or jointly with others, execute a guaranty in his/her/its favor.  Each undersigned understands that Collegiate Peaks Bank is relying on the information provided herein (including the designation made as to ownership of property) in deciding to grant or continue credit.  Each undersigned represents and warrants that the information provided is true and complete and that Collegiate Peaks Bank may consider this statement as continuing to be true and correct until a written notice of a change is given to Collegiate Peaks Bank by the undersigned.  Collegiate Peaks Bank is authorized to make all inquiries it deems necessary to verify the accuracy of the statements made herein, and to determine the creditworthiness of the undersigned.  Collegiate Peaks Bank is authorized to answer questions about the credit experience with Collegiate Peaks Bank of the undersigned.
 |  |  |  | IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Signature (Applicant) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Signed
 |  |  |  | To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.  What this means for you: When you open an account, we will ask you for your name, address, date of birth, social security number, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Social Security Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date of Birth
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Signature (Co-Applicant) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Signed
 | Form Last Updated: 4/3/2012 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Social Security Number |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date of Birth