Initial Financial Summary

Summary of Your Financial Details:

Filling out the information on this form will help streamline and help prepare both you and me for your initial appointment. Please be as thorough as possible so that together we can create a plan that will work best for you and your family.
Your Name*

First NameLast Name
Spouse Name

First NameLast Name
Your Contact Number*

Area CodePhone Number
Your E-mail
How did you hear about us?*
Your Occupation *
Your Monthly Income*
Your Spouse's Occupation *
Your Spouse's Monthly Income*
Other Household Income*
Side Hustle's, Part-time jobs, etc.
Income Information: How often do you get paid?*

WeeklyEvery Other WeekTwice a MonthMonthly
Income Information: How often does your spouse get paid?*

WeeklyEvery Other WeekTwice a MonthMonthlyNo monetary compensation
Monthly Mortgage or Rent Payment?*
Second mortgage payment?*
Vehicle #1 monthly payment?*
Vehcile #2 monthly payment?
Credit Card #1 monthly payment?*
Credit Card #2 monthly payment?
Credit Card #3 monthly payment?
Credit Card #4 monthly payment?
Student Loan #1 monthly payment?*
Student Loan #2 monthly payment?
Monthly Utility Bills: Electric
Propane/Natural Gas
Water
Trash
Phone #1
Phone #2
Other Phones
Internet
Cable
Other
Groceries
Clothing
Car Maintenance/Gas
Medical monthly payments
Other Monthly Bills
Other Monthly Bills
Please provide this information to me as soon as possible and preferably 48 hours prior to appointment time. Please gather and have available any additional or missing information for the meeting.

Please note the information you provide is confidential. In addition please DO NOT provide account numbers, your employee number, or personal identification numbers.
Number
Should be Empty:

Summary of Your Financial Details: