The purpose of this form is to help you in gathering the basic information about your current financial situation which we will need in order to make the best use of our time together. Without knowing everything one is doing financially, it is next to impossible to discuss options available because what may be right in one set of circumstances may be harmful in another. All information provided will be kept strictly confidential. Important Notes/Unique Circumstances Rent Information Due Date Mortgage Information Please complete the fields only as they apply to you. If you do not have a second mortgage or a HELOC, leave those areas blank. Any additional information that you feel is pertinent please list in the additional Notes/Information area. *If you pay property taxes and homeowner’s insurance separately rather than as part of your mortgage payment, list them below in the Expenses section. Ist Mortgage Original Start Date Date of Month Due 2nd Mortgage Original Start Date Date of Month Due HELOC (if applicable) Date of Month Due Income Information Please note that income should reflect net checks after taxes, 401(k) contributions, and stock purchases. Complete only as it applies to your circumstances. Your Primary Income Date of Month Paid Date of Bonus Payment (if applicable) Additional/Ancillary Income 1 Date of Month Paid Additional/Ancillary Income 2 Date of Month Paid Expense Information Please do not hesitate to edit our template so that it accurately reflects your circumstances (example: many clients have cable and internet as one bill). We’ve also included blank fields so that you can add ones we may have missed. However, please be sure to always indicate the interval of the expense (weekly, monthly, quarterly, annually, etc) and the date paid/due as this will help us accurately understand your cash flow. Expense Name Household Expenses Amount Interval Date Paid/Due Property Taxes WeeklyMonthlyAnnuallyQuarterly Homeowner’s Insurance WeeklyMonthlyAnnuallyQuarterly Car Insurance WeeklyMonthlyAnnuallyQuarterly Property Taxes WeeklyMonthlyAnnuallyQuarterly Life Insurance WeeklyMonthlyAnnuallyQuarterly Electricity WeeklyMonthlyAnnuallyQuarterly Water WeeklyMonthlyAnnuallyQuarterly Garbage WeeklyMonthlyAnnuallyQuarterly Cell Phones WeeklyMonthlyAnnuallyQuarterly Cable WeeklyMonthlyAnnuallyQuarterly Internet WeeklyMonthlyAnnuallyQuarterly Cleaning WeeklyMonthlyAnnuallyQuarterly Property Maintenance WeeklyMonthlyAnnuallyQuarterly Groceries WeeklyMonthlyAnnuallyQuarterly Entertainment WeeklyMonthlyAnnuallyQuarterly Gas WeeklyMonthlyAnnuallyQuarterly Gifts WeeklyMonthlyAnnuallyQuarterly Clothing WeeklyMonthlyAnnuallyQuarterly School Expenses WeeklyMonthlyAnnuallyQuarterly Vacation Budget WeeklyMonthlyAnnuallyQuarterly Christmas Budget WeeklyMonthlyAnnuallyQuarterly Savings WeeklyMonthlyAnnuallyQuarterly Religious Contributions WeeklyMonthlyAnnuallyQuarterly WeeklyMonthlyAnnuallyQuarterly WeeklyMonthlyAnnuallyQuarterly WeeklyMonthlyAnnuallyQuarterly WeeklyMonthlyAnnuallyQuarterly Any other info needed Debt Information Please include all debts, balances, minimum payments, monthly payment you make (if above the minimum),interest rates, dates paid, and anticipated pay-off dates. Car payments/loans, credit cards, and other loans should all be included. Date Paid/Due Payoff Date Date Paid/Due Payoff Date Date Paid/Due Payoff Date Date Paid/Due Payoff Date Date Paid/Due Payoff Date Date Paid/Due Payoff Date Date Paid/Due Payoff Date Date Paid/Due Payoff Date College Information When formulating a long-term plan, we want to be sure that we take into account expected college bills and debt. If we do not plan for it now, college can become a significant roadblock in our financial future. Please provide us with both the names of your students and year you expect them to enter college for the first Fall semester. Enters college Fall of...... 20192020202120222023202420252026202720282029203020312032203320342035 Enters college Fall of...... 20192020202120222023202420252026202720282029203020312032203320342035 Enters college Fall of...... 20192020202120222023202420252026202720282029203020312032203320342035 Enters college Fall of...... 20192020202120222023202420252026202720282029203020312032203320342035 Enters college Fall of...... 20192020202120222023202420252026202720282029203020312032203320342035 Enters college Fall of...... 20192020202120222023202420252026202720282029203020312032203320342035 Save and Continue Later
