Financial Overview

Completing this form will help me prepare for our consultation. Once submitted, I will review your information and confirm our appointment. I am a service-based business and do not sell any financial products and all information shared is kept confidential. I look forward to helping you take control of your finances!

Your Name

First Name

Last Name

Your Email Address

Your Cell Phone

(###)

###

####

Spouse's Name

First Name

Last Name

Spouse's Email

Spouse's Cell Phone

(###)

###

####

How often do you get paid?

Your Approximate Take Home Pay Each Check

How Often Your Spouse Gets Paid

Spouse's Approximate Take Home Pay Each Check

How Much In Personal Savings

Monthly Mortgage or Rent Payment

Approximate House Value

Approximate Mortgage Balance

Number of Dependents Living With You

Car Payment #1

Car Payment #2

Approximate Owed

Approximate Total Credit Card Debt

Approximate Student Loan Debt

Do you have outstanding loans on your retirement plan?

Yes

Do you owe money to family or friends?

Yes

Income Taxes

Receive $1,00 or less refund

Receive over $1,000 refund

Have to pay in

Owe back taxes

Still need to file taxes

What specific concerns do you want covered during your session?