OWENS CAPITAL APPLICATION CENTER

Personal Financial Statement

Complete your personal financial information below. Your totals and net worth will be calculated automatically.

WET SIGNATURE REQUIREDAfter generating the completed statement, print the signature page and sign it by hand. A typed name does not replace the required handwritten signature.

Privacy notice: The information entered on this page is processed in your browser to create your completed PDF. It is not submitted to a public website database from this form.

1. Personal Information

Applicant Full Name *

Statement Date *

Date of Birth

Home Address *

City *

State *

ZIP Code *

Phone

Email *

Last 4 Digits of SSN

2. Employment & Income

Employer or Business Name

Job Title or Occupation

Years Employed

Annual Salary / Self-Employment Income

Other Annual Income

Source of Other Income

3. Assets

Cash and Bank Accounts

Retirement Accounts

Stocks and Other Investments

Primary Residence Market Value

Other Real Estate

Vehicles and Personal Property

Business Ownership Interests

Other Assets

Total Assets$0

4. Liabilities

Home Mortgage Balance

Other Real Estate Loans

Vehicle Loans

Credit Card Balances

Student Loans

Personal Loans

Taxes, Liens or Judgments

Other Liabilities

Total Liabilities$0

5. Net Worth Summary

Total Assets

Total Liabilities

Net Worth

6. Monthly Obligations

Housing Payment

Vehicle Payments

Credit Cards & Other Debt

Child Support or Alimony

Other Monthly Obligations

7. Basic Disclosures

Have you filed bankruptcy within the last seven years?

YesNo

Do you have any outstanding tax liens or judgments?

YesNo

Are you involved in any pending lawsuits?

YesNo

Are you a guarantor or co-signer on another person's debt?

YesNo

Are any debts currently past due?

YesNo

Explanation

8. Certification & Signature

I certify that the information in this statement is true, complete and current to the best of my knowledge. I authorize Owens Capital and its financing partners to verify the information provided as permitted by law.

Applicant Printed Name *

Date *

WET SIGNATURE REQUIRED AFTER PRINTINGYour handwritten signature is not entered through this website. Download the completed statement, print the signature page and sign it by hand.

Generate Your Personal Financial Statement

Review your information carefully. Your completed Owens Capital Personal Financial Statement PDF will be ready to save below.

After You Sign

Scan or photograph the complete signed document and upload it only through your secure Owens Capital client portal.

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