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FINANCIAL REVIEW INFO
The more information the better. This will cover your budget, life insurance, debt, emergency funds & long term investments. Tailored strategy will be discussed in your next appointment.
CLIENT PROFILE:
Page 1 of 6
Name:
*
First & Last
Spouse Name:
First & Last
D.O.B:
*
-
Month
-
Day
Year
Date
Spouse D.O.B:
-
Month
-
Day
Year
Date
Gender:
*
Please Select
Male
Female
Other
Mobile Phone:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
*
example@example.com
Address:
*
Street Address
Street Address 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Dependents:
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BUDGET & EMPLOYMENT:
Page 2 of 6
Employer:
*
Company Name, Self-Employed or Un-Employed
Length of time with employer:
*
Years
Monthly Income:
*
Take home after taxes (Net Income)
Spouse Income:
Take home after taxes (Net Income)
Expenses:
*
Rows
MONTHLY EXPENSE:
MORTGAGE/RENT(Insurance,Taxes)
AUTO (Payment, Fuel, Insurance, Tolls)
FOOD(Grocery shopping, Dining out)
UTILITIES(Cable/Internet, Gas, Phone, Water)
Debt Payments(Add all monthly payments)
Misc(Subscriptions, Amazon, Shopping, Personal Care, Travel, Healthcare, Childcare, Landscaping)
Total Expenses:
Total Discretionary:
$ Amount available to utilize
Does your discretionary feel accurate?
Yes
No
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LIFE INSURANCE INFO:
Page 3 of 6
Do you have Life Insurance?
*
Please Select
Yes
No
Only through my job
Need help locating
Company Name:
Insurance Type:
Please Select
Term Life
Whole Life
Universal Life
Indexed Universal Life
Final Expense
Death Benefit:
Monthly Premium:
Year obtained:
Statement Upload:
Browse Files
Drag and drop files here
Choose a file
Add Life Insurance statement/policy here
Cancel
of
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Next
DEBT INFORMATION:
Page 4 of 6
Debt Info:
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Next
EMERGENCY FUNDS:
Page 5 of 6
Savings Info:
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Next
LONG TERM INVESTMENTS:
Page 6 of 6
Retirement & Investment Accounts
Statement upload:
Browse Files
Drag and drop files here
Choose a file
Retirement account, Investment Account, etc.
Cancel
of
Appointment
Submit
Should be Empty: