DEBT ANALYSIS FORM

Personal Savings Report Appointment

Money Max Debt Worksheet
Tell Us About Your Debt

Please take a moment to watch the video below. After viewing, complete the Personal Savings Analysis so that all of your debt information can be entered into the Money Max Program to provide you with an estimated payoff plan. The Submit button will appear once all applicable fields have been completed.

Thank you for your time, and I look forward to meeting with you during your appointment. If you have any questions, please do not hesitate to contact me at (313) 354-4013.
Full Name

PrefixFirst NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
What is your gross annual income ?
What is your combined approximate savings per month?
Mortgages

List all mortgages that you have. For each mortgage, include principal, interest, escrows, PMI/Mortgage insurance, etc.

Rows	Type of Loan	Mortgage Balance	Interest Rate	Monthly Required Payment with Escrow	Monthly Escrow	Monthly Extra Principal Payment	Mortgage Insurance Payment
Home
Other Property
Other Property
Other Property

Rows	Account Name	Current Balance	Interest Rate	Required Monthly Minimum Payment	Extra Monthly Principal Payment
Loan Type
Loan Type
Loan Type
Loan Type
Loan Type
Loan Type
Loan Type
Loan Type
Loan Type
Loan Type

Revolving Credit

Include: LOC- Line of Credit, Credit Card, HELOC – Home Equity Line of Credit

Rows	Type of Creditor	Current Balance Payment	Credit Limit	Interest Rate	Required Minimum Monthly Payment	If 0% interest indicate new interest rate
Creditor
Creditor
Creditor
Creditor
Creditor
Creditor
Creditor
Creditor
Creditor
Creditor

Average Household Net Income

Weekly, Bi-Week, Monthly, Twice a Month, Quarterly, Bi-Annually (every 6-months), Once a Year (Include any Rental/Investment monthly income.)

Rows	Income Source	Payment Frequency	Average Net Income Per Paycheck
1
2
3
4
5
6

Monthly Living Expenses All Other Monthly Bills - Food, Gas, Utilities, Insurance, Phones, Internet, etc. (Do not include Creditors already entered.)
Monthly Discretionary Income: Money to set aside after all creditors & living expenses have been paid.
Do you have any Personal insurance objectives? (Please elaborate)
Profection & Risk Planning

Eliminating debt is important and securing your financial future for the rest of your life is too. Please take a moment to answer a few insurance questions. Having the right insurance can fund your future, retirement, pay for education, household renovations and other financial needs that you never could imagine possible.
Do you currently have Final Expense or Mortgage Protection coverage?
What is your number? To find out, take 100 and subtract your age from that amount. This is the number you will need each month to live comfortably in retirement. Are you prepared?
If you have any, is your current Annuity, Index Universal Life (IUL), Whole Life, and or, term life policy more than 3 years old?
Do you currently have Final Expense or Mortgage Protection Coverage?
Do you have Long-Term Health Care coverage?
Do you have a 401K, 403b or any other investment asset that you would like to see if it is earning you permanent income until age 109?

If you have child(ren) would you like to plan for your child(ren)'s education? If so, please indicate your preferences and approximate cost.

Personal Savings Report Appointment