Mike's Snap Shot Form
MoneyCoachMike's
High Performance Financial Coaching
Name
First Name
Last Name
Type of Work
Spouse Name
First Name
Last Name
Type of Work
Number of Dependents
Phone Number
*
-
Area Code
Phone Number
Income
What is your monthly take home pay?
Do you have irregular income?
Yes
No
Do you use a monthly budget?
Yes
No
Savings
Do you have an emergency fund?
Yes
No
How much is in the fund?
Are you currently investing for retirement?
Yes
No
What is your balance?
What is your monthly contribution?
Do you contribute to non-retirement savings?
Yes
No
What is your monthly contribution?
Housing
Are you current on your payment?
Yes
No
What are your total monthly payments?
Consumer Debt
Do you have vehicle loans?
Yes
No
Are you current on vehicle payments?
Yes
No
What are your total monthly payments?
List other total balances due:
Credit Cards
Student Loans
Taxes
Lines of Credit
Other
How have you tried fixing this problem?
Why haven't you been able to solve this issue in the past? ( be honest ;)
On a scale of 1- Bruce Lee how awesome are you?
Submit
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