Personal Financial Statement

This form is used to calculate your net worth (assets minus liabilities). Please fill out the information to the best of your ability. If your account manager has asked you to submit this, this is the place to do it.

Information submitted here goes directly to your account manager. We treat all financial information as strictly confidential and never share it with third parties without your written consent.

Before you start

You'll need approximate dollar values for everything you own and everything you owe. Round numbers are fine.
For each section, list the detail (vehicles, real estate, etc.) in the textarea, then enter the total value and total amount owed in the boxes below it.
Total Assets, Total Liabilities, and Net Worth update live as you type.
If a section doesn't apply to you, leave it blank or enter 0.
You can attach supporting documents (tax returns, bank statements, etc.) at the bottom.
Plan on 10-15 minutes to complete.
If a question is confusing, save what you have, then call 208-534-8525 — we'll walk through it on the phone.

Applicant

Name of applicant *
Today's date *

Employment Employment (other than self-employed). Please provide name and address of current employer along with phone number, contact person, how long employed, and annual income.
If self-employed: please list type of work, how long, gross annual income, and net annual income.

Cash What is the combined total of all your cash? (Include all bank accounts, cash, uncashed checks, etc.)

Vehicles owned

List make, model, year, value, amount owed, and monthly payment for each vehicle (personal and commercial). Example: 2006 Toyota Tacoma $15,000. Owe $5,000. Payment $300/mo. 2007 FRTL Columbia $30,000. Owe $12,000. Payment $600/mo. 2009 Sterling Dump-truck $75,000. Owe $0.

Total value of all vehicles
Total amount owed on all vehicles

Other commercial equipment owned

List additional commercial equipment owned (not listed in the Vehicles section). Examples: Welder $5,000. Owe $0. 2006 Fontaine Flatbed Trailer $12,000. Owe $0. Farm Equipment $50,000. Owe $20,000. Payment $600/mo. Construction Equipment $20,000. Owe $2,000. Payment $300/mo.

Total value of other commercial equipment
Total amount owed on other commercial equipment

Real estate

Please list all real estate owned with descriptions, addresses, value, amount owed, and monthly payment. Example: 1994 Single Family Home, 123 Front Street, Salt Lake City, UT — Value $100,000, Owe $0. 2007 Condo, 1245 Deer Creek Dr, Park City, UT — Value $120,000, Owe $100,000, Payment $1,000/mo.

Total value of real estate owned
Total amount owed on all real estate

Household goods What is the value of all your household goods? (Furniture, jewelry, guns, artwork, etc.)

Other assets

List other assets and their value. (Stocks, retirement funds, accounts receivable, etc.) Example: Equity in XYZ Small Business $200,000. 401k $60,000. Stocks $5,000. Accounts Receivable $3,000. Livestock $12,000.

Total value of other assets

Credit cards How much do you owe on credit cards?

Other liabilities

Describe other liabilities not mentioned in other sections. Examples: Student Loans $120,000. Payment $1,000/mo. Back Taxes $10,000. Business Loan $12,000. Payment $500/mo.

What is the total of other liabilities?

Net worth (auto-calculated)

Total Assets: $0

Total Liabilities: $0

Net Worth: $0

Attachments (optional)

Tax returns, bank statements, business financials, or anything else your account manager has requested. PDF, JPG, PNG, DOCX, XLSX, CSV all work.

Acknowledgment The applicant acknowledges that the statements made on this sheet are true and accurate.

Questions while filling this out?
Call 208-534-8525 · A real person picks up