Personal Financial Snapshot
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Email *
Appointment Date *
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Full Name *
Spouse's Full Name (if applicable)
Street Address *
Apt / Unit
City / Town *
State *
Zip Code *
Phone Number *
Please confirm that you can meet via Video Conference for your consultation. *
Your age *
Spouse's age (if applicable)
Your occupation *
Spouse's occupation (if applicable)
Have you been through Financial Peace University (FPU)? *
Number of children/dependents *
How did you find Beantown Money? *
INCOME
Please estimate your monthly net take-home pay ($)? *
Do you have an irregular or inconsistent income? *
Do you create a financial plan (budget) each month? *
SAVINGS
How much cash on hand do you have in total ($)? Generally this means cash in checking, savings, and money market type accounts but would not include your 401(k) or retirement accounts. *
Are you currently investing for retirement? *
If so, what is your total current balance in all retirement accounts ($)?
If so, what is you monthly contribution ($)?
HOUSING
What is your current housing situation? *
Is your housing payment up to date?
 *
What is your total monthly housing payment ($)? *
If you own your home, what is its current estimated value ($)?
If you own, what is the balance of your mortgage ($)?
Do you have a Home Equity Loan or second mortgage? *
If so, what is the balance of the loan ($)?
CONSUMER DEBT
Do you have any vehicle loans? *
If so, are you current on your vehicle payments?
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What are your total vehicle monthly payments ($)?
What is the balance of the vehicle loans ($)?
How many credit cards do you have? *
What is the total balance on all credit cards ($)?
What is the total balance on any student loans ($)? *
Do you have any unpaid taxes from previous years?
 *
Is so, what is the balance ($)?
OTHER
Is there anything else you would like to mention or feel should be included to fully understand your personal financial situation?
FOCUS
What primary issues should we focus on? *
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Please list the top concerns or questions related with the question above. *
FINANCIAL COACHING AGREEMENT
Please confirm that you have read and agree with the Financial Coaching Agreement available at BeantownMoney.com/resources. Note: Session cancellations less than 24-hours in advance may be subject to a $100 fee.
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