Personal Financial Snapshot

PERSONAL FINANCIAL SNAPSHOT

Thank you for your payment! The next step is to complete this Financial Snapshot form. Please gather your financial documents (e.g bank statements, pay stubs, outstanding balances, current budget) and allot at least 15 minutes for completion.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone*
Type of work*
Relationship Status*

SPOUSE INFORMATION
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Email
example@example.com
Spouse Phone Number

Area CodePhone Number
Spouse Type of work

ADDITIONAL INFORMATION
Number of Children or Other Dependents*
Have you been through Dave Ramsey's Financial Peace University?*

YesNoWhat's Financial Peace University?
Do you use a monthly budget?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

INCOME
What is your monthly net take-home pay?*
Do you have an irregular income?*

YesNo

SAVINGS
Do you have an emergency fund?*

YesNo
How much is in the fund?
Are you currently investing for retirement?*

YesNo
What is your balance?
What is your monthly contribution?
Do you contribute to non-retirement savings?*

YesNo
What is your balance?
What is your monthly contribution?

HOUSING
Do you rent or own?*

RentOwn
Are you current on your payments?*

YesNo

CONSUMER DEBT BALANCES

Please complete the below balances due to the best of your ability. Estimates are OK. If not applicable, please enter 0 in the box.
Are you debt free?*

YesNo
List any balance due on your vehicle *
List any balance due on your credit cards*
List any balance on your student loans*
List any balance due on your taxes*
List any balance due on any other outstanding debt*

OUR SESSION
What primary issue should we focus on during your coaching session?*

BudgetingReal EstateDealing with CollectorsWealth Building/InvestingDebt EliminationOther
List the TOP THREE concerns/questions related to your above selection:*
How did you find out about Powerful People Plan?
Newsletter*

Yes, subscribe me to the Powerful People Plan monthly newsletter and other useful material until I unsubscribe
Should be Empty: