Debts, Income, Mortgage, Education

First Name:*

Last Name:*

Email:*

Debts

Student Loans:*

Car Loans:*

Credit Cards:*

Monthly:*

Total:*

Income

If you or your spouse could not work again, how much income would you need to sustain your current lifestyle?*

/month

Mortgage

What do you think your house is worth (in dollars)?

What is your current balance on your home mortgage (in dollars)?

Current Balance #2 (in dollars):

Monthly Payment (in dollars):

Type of Loan:
FixedAdjustable

Interest Rate (in percentage):

Number of Years:

Education

Would you like to provide for your children's education?*
AllPart

Approximate Cost for Education (in dollars):*

Amount Saved (in dollars):*

CURRENT LIFE INSURANCE

Client Name:*

Type:*

Policy Amount:*

Monthly Payment:*

Client's Carrier:*

Spouse Name:*

Type:*

Policy Amount:*

Monthly Payment:*

Spouse's Carrier:*

Our goal is to offer recommendations that, in your opinion, are better for you and your family in every way. Please schedule a day and time for us to speak to you (spouse).

Would you be kind enough to refer our services to 8-10 people like yourself?
Yes

Date of our next meeting:

Time:

BPM: