Investment Planners Financial Budget
Full Name
*
First Name
Last Name
What is your age?
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Are you a current client or a perspective client?
Please Select
Current Client
Perspective Client
Relationship status
Please Select
Single
Married
Divorsed
Widow
Do you have children?
Yes
No
If you have children, what are their names and date of births?
Do you have grandchildren? If so, what are their names and date of births?
How much do you have in savings?
What is your monthly income?
Do you receive Social Security? If so, what is your monthly amount?
Do you receive a pension? If so, what is your monthly amount?
How much do you pay in mortgage and/or rent?
What is your home purchase year and amount?
What is the current market value of your home?
How much do you pay in home/rent insurance?
How much do you pay in Real Estate Taxes?
How much do you pay in utilities? *
*
How much annually do you pay in home repairs and/or improvement?
How much do you spend on groceries monthly?
How much do you spend on dining out monthly?
How much do you spend on house cleaning services monthly?
How much do you spend monthly on cell phone payments?
How much do you spend on transportation monthly? (gas, train, etc.)
How much do spend on auto insurance?
Do you have any other expenses?
Yes
No
Approximately how much do you spend on the above extra expenses?
How much do you spend on Cable TV monthly?
How much do you spend on video rentals or online video subscriptions monthly?
How much do you spend on movies/shows monthly?
How much do you spend on wifi?
How much do you donate to charity yearly?
How much do you spend monthly on clothing?
How much do you spend monthly on gifts?
How much do you spend monthly at the hair salon?
How much money do you have in your emergency savings?
How much is in your retirement fund? (401K, Roth IRA, 403B, etc.)
On average how much are your monthly credit card payments? (Excluding amounts already covered by previous questions)
How much do you pay in income tax?
Submit
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