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TELEPHONE NUMBER S I 1 % OF OWNERSHIP TIME WITH COMPANY: OFFICE TELEPHONE NUMBER 3. BANKING & 01 HLR CREDIT CARD RELATIONSHIPS PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? OYES ONO VISA BUSINESS OR CORPORATE CARD? PYFS nNo MASTERCARD BUSINESS OR CORPOR

% OF OWNERSHIP TIME WITH COMPANY: OFFICE TELEPHONE NUMBER 3. BANKING & 01 HLR CREDIT CARD RELATIONSHIPS PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? OYES ONO VISA BUSINESS OR CORPORATE CARD? PYFS nNo MASTERCARD BUSINESS OR CORPORATE CARD? OYES ONO BUSINESS C

TH COMPANY: MONTHLY MORTGAGE/RENTAL PAYMENT $ % OF OWNERSHIP TIME WITH COMPANY: HOME TELEPHONE NUMBER OFFICE TELEPHONE NUMBER 3. OTHER BANK: Chase Bank OF ACCOUNT(S): Personal account of Guarantor ' OTHER ACCOUNTS OLOAN OSAVINGS ACCT °CREDIT CARD PRIMARY BANK B S H CKING ACCOUNT # Palm Beach B

Chase Bank OF ACCOUNT(S): Personal account of Guarantor ' OTHER ACCOUNTS OLOAN OSAVINGS ACCT °CREDIT CARD PRIMARY BANK B S H CKING ACCOUNT # Palm Beach Bank nCHECKING ACCOUNT (LOAN f13AVINGS ACCOUNT nCRFDIT CARD AMERICAN EXPRESS ACCOUNT NUMBER: DATE OPENED: BALANCE: CORPORATE CARD? nYFS nNo VISA

HOME TELEPHONE NUMBER 1 % OF OWNERSHIP TIME WITH COMPANY: OFFICE TELEPHONE NUMBER 3. BANKING & OTHER CREDIT CARD RELATIONSHIPS PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? OYES ONO VISA BUSINESS OR CORPORATE CARD? DYES ONO MASTERCARD BUSINESS OR CORPOR

1 % OF OWNERSHIP TIME WITH COMPANY: OFFICE TELEPHONE NUMBER 3. BANKING & OTHER CREDIT CARD RELATIONSHIPS PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? OYES ONO VISA BUSINESS OR CORPORATE CARD? DYES ONO MASTERCARD BUSINESS OR CORPORATE CARD? DYES ONO IMISING A

T HOME TELEPHONE NUMBER % OF OWNERSHIP TIME WITH COMPANY: OFFICE TELEPHONE NUMBER BANKING & 01 HLR CHL.L)I I CARD RELA I :U:.SH PS PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? OYES ONO VISA BUSINESS OR f:ORPORATF CARO? nyes PNO MASTERCARD BUSINESS OR CORPO

% OF OWNERSHIP TIME WITH COMPANY: OFFICE TELEPHONE NUMBER BANKING & 01 HLR CHL.L)I I CARD RELA I :U:.SH PS PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? OYES ONO VISA BUSINESS OR f:ORPORATF CARO? nyes PNO MASTERCARD BUSINESS OR CORPORATE CARD? OYES ONO IIIIIIMIM

DRESS: STREET: APT#: CITY: STATE: ZIP CODE: YEARS AT ADDRESS OWNERSHIP STATUS: TIOWN FIRENT MOTHER: POSITION WITH COMPANY: 3 PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? nYES nNo VISA BUSINESS OR CORPORATE CARD? nYES nNo MASTERCARD BUSINESS OR CORPOR

ITY: STATE: ZIP CODE: YEARS AT ADDRESS OWNERSHIP STATUS: TIOWN FIRENT MOTHER: POSITION WITH COMPANY: 3 PRIMARY BANK Chase Bank OTHER BANK: Palm Beach Bank AMERICAN EXPRESS CORPORATE CARD? nYES nNo VISA BUSINESS OR CORPORATE CARD? nYES nNo MASTERCARD BUSINESS OR CORPORATE CARD? OYES ONO MONTHLY MO