Personal Financial Snapshot
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Personal Information
Name
First Name Last Name
Age
Email
example@example.com
Phone Number
Mailing Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Are you married?
Yes No
Spouse's Name
First Name Last Name
Spouse's Age
Type of Work
Spouse's Type of Work
Preferred method of contact for our coaching sessions?
In Person Phone Video Conference
Financial Information
Income I Savings I Housing I Debt
INCOME
What is your monthly net take-home pay?
Do you have an irregular income?
Yes No
Do you use a monthly budget?
Yes No
SAVINGS
Do you have an emergency fund?
Yes No
How much is currently in the fund?
Are you currently investing for retirement?
Yes No
What is your current balance?
What is your monthly contribution?
Do you contribute to non-retirement savings?
Yes No
What is your current balance?
What is your monthly contribution?
HOUSING
Do you rent or own?
Rent Own
Are you current on your payment?
Yes No
What are your total monthly payments?
CONSUMER DEBT
Do you have any vehicle loans?
Yes No
Are you current on your vehicle payment(s)?
Yes No
What are your total monthly vehicle payments?
Do you have balances due on any other types of debt?
Credit Cards Student Loans Taxes Other
Credit card(s) balance
Student loan(s) balance
Tax balance
Other balance
What primary issue should we focus on during our coaching session?
Budgeting Real Estate Dealing with Collectors Wealth Building/Investing Debt Elimination Other
List your top concerns/questions related to your selection above
Should be Empty: