Personal Financial Snapshot
Please complete to the best of your ability. This will save time and give us the necessary background for our session.
Email address *
Appointment Date *
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Full Name *
Your answer
Spouse's Full Name (if applicable)
Your answer
Full Address (Street, Apt, City/Town, Zip) *
Your answer
Phone Number *
Your answer
Preferred method of contact for first session (in-person is preferred for local clients after the first session) *
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Your age *
Your answer
Spouse's age (if applicable)
Your answer
Your occupation *
Your answer
Spouse's occupation (if applicable)
Your answer
Have you been through Financial Peace University (FPU)? *
Number of children/dependents *
INCOME
What is your monthly net take-home pay ($)? *
Your answer
Do you have an irregular or inconsistent income? *
Do you use a monthly budget? *
SAVINGS
Do you have an emergency fund? *
If so, how much is in your emergency fund ($)?
Your answer
How much cash on hand do you have in total ($)? Generally this means cash in checking, savings, and money market type accounts but would not include your 401(k) or retirement accounts. *
Your answer
Are you currently investing for retirement? *
If so, what is your total current balance in all accounts ($)?
Your answer
If so, what is you monthly contribution ($)?
Your answer
HOUSING
Do you rent or own? *
Are you current on your housing payment? *
What is the total of your monthly housing payment ($)? *
Your answer
If you own, how much is your home currently worth ($)?
Your answer
If you own, what is the balance of your mortgage ($)?
Your answer
Do you have a Home Equity Loan or second mortgage? *
If so, what is the balance of the loan ($)?
Your answer
CONSUMER DEBT
Do you have any vehicle loans? *
If so, are you current on your vehicle payments?
What are your total vehicle monthly payments ($)?
Your answer
What is the balance of the vehicle loans ($)?
Your answer
How many credit cards do you have? *
Your answer
What is the total balance on credit cards ($)?
Your answer
What is the total balance on any student loans ($)? *
Your answer
Do you owe any back taxes? *
Is so, what is the balance ($)?
Your answer
OTHER
Is there anything else you would like to mention or feel should be included to fully understand your personal financial situation?
Your answer
FOCUS
What primary issue should we focus on during your coaching session? *
Required
List the top three concerns or questions related with the question above. *
Your answer
FINANCIAL COACHING AGREEMENT
Please confirm that you have read and agree with the Financial Coaching Agreement available at BeantownMoney.com/resources. (Revision 20200207). Note: Session cancellations less than 24-hours in advance may be subject to a $50 fee.
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A copy of your responses will be emailed to the address you provided.
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