INSTRUCTIONS
Client Name:
INSTRUCTIONS FOR PRELIMINARY WORK
MONTHLY INCOME SOURCES
List all regular net income sources
List all irregular net income sources (I.e. commissions, bonuses, etc.)
Other income (I.e. tax refunds, rents, etc.)
Self-employment income
CONSUMER EQUITY
List all assets
List estimated market value as well as payoff of secured debt
List unsecured debt
BASIC BUDGET
Add categories when necessary
Remember non-monthly annual lump sum totals
Include payments on debt listed under "Consumer Equity"
DEBT SNOWBALL
List all debts, smallest amount to largest
List minimum payments due
Leave out debts attached to assets listed under "Consumer Equity" for which the
monthly payments are included in your "Basic Budget"
Fax or email forms at least 24 hours before scheduled appointment date.
E-mail: steve@HISconsulting.BIZ
Phone: (412) 563-5856 or (412) 805-5856 (cell)
fax: (412) 341-8683
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b3100711-5193-405d-a0ca-b53305a04e4d.xls Instructionsof 14 10/24/2011
COUNSELING PRIORITY ANALYSIS
Client Name: 0
COUNSELING PRIORITY ANALYSIS
Identify your top 3 priorities with "1" "2" or "3" for the next 6 months.
______ Developing a Money Spending Plan (a.k.a. "budget")
______ Personal Debt elimination
______ Establishing an Emergency/Opportunity Savings Fund
______ Estate Planning - Wills & Trusts
______ Career Planning
______ Retirement Planning / Financial Independence Planning
______ Investment Planning
______ Business Development - Planning
______ Other Goals: __________________________________________
______ Other Goals: __________________________________________
What issues would you like to discuss during our meeting?
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b3100711-5193-405d-a0ca-b53305a04e4d.xls Priorities 2 of 14 10/24/2011
PREPARING FOR YOUR SESSION
Client Name: 0
PREPARING FOR YOUR SESSION
Things you need to bring:
-- Two years of tax returns.
-- A copy of your monthly budget or monthly expenses
-- A list of all household income sources.
-- A complete list of all debts (including, but not limited to, credit cards,
student loans, mortgages, etc.). For each item in this list, include the
current minimum payment and the total payoff
-- A list of all insurances (including, but not limited to, health, life, disability,
car, homeowner, etc.). For each item in this list, include current deductible
and all possible deductibles.
-- A thorough list of all financial assets (including, but not limited to, savings,
401Ks, IRAs, CDs, etc.).
-- Present market values of all real estate owned.
-- If you own your own business (as a sole proprietorship), include all relevant
company documents (including company P & L statements).
MOST IMPORTANTLY
Bring a list of all pertinent questions that you would like answered!
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b3100711-5193-405d-a0ca-b53305a04e4d.xls Preparation 14 10/24/2011
INCOME SUMMARY
Client Name:
Types of Income Monthly Amount Irregular
Point to red comment triangles for extra help
Income 1
Income 2
Income 3
Interest/Rents/Misc
Tax Refund
Other
Other
Other
Other
Self-Employment
Only enter data above this line
TOTAL INCOME
- TOTAL NECESSITIES BASIC BUDGET
= DISPOSABLE INCOME
- DEBT PAYMENT DEBT SNOWBALL
= EXTRA FOR DEBT
REDUCTION
and/or SAVINGS
REFERENCE INFORMATION
EMERGENCY FUND
3X Monthly Necessities
LIFE INSURANCE
8X Annual Income
Page 4 of 14
b3100711-5193-405d-a0ca-b53305a04e4d.xls INCOME-SUMMARY 10/24/2011
EQUITY
Client Name: -
ITEM DESCRIPTION VALUE - DEBT = EQUITY
Real Estate 1 -
Second Mortgage -
Real Estate 2 -
Second Mortgage -
Real Estate 3 -
Second Mortgage -
Car 1 -
(year____ make _______ model ___________ miles ________)
Car 2 -
(year____ make _______ model ___________ miles ________)
Car 3 -
(year____ make _______ model ___________ miles ________)
Cash on Hand -
Checking Account 1 -
Checking Account 2 -
Savings Account 1 -
Savings Account 2 -
Money Market Account -
Mutual Funds -
Retirement Plan 1 -
Retirement Plan 2 -
Retirement Plan 3 -
Stocks or Bonds -
Insurance (Cash Value) -
Household Items -
Jewelry -
Antiques -
Other -
Other -
Other -
Other -
Other -
Other -
Other -
TOTAL - - -
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b3100711-5193-405d-a0ca-b53305a04e4d.xls EQUITY 5 of 14 10/24/2011
BUDGET
Client Name: -
Nonmonthly Envelope
ITEM DESCRIPTION
Monthly Total Savings Total Actual Total
GIVING
Charity
Church
Other
SAVINGS
Emergency Fund
Other
HOUSING
First Mortgage/Rent
Homeowner's Insurance
Property Taxes
Repairs/Upkeep
Second Mortgage
UTILITIES
Cell Phone
Electricity
Internet
Natural Gas
Oil
Sewer
Telephone
Television (Cable/Satellite)
Trash
Water
FOOD
Eating Out
Groceries
TRANSPORTATION
Car Insurance
Car Payment
Gasoline/Diesel
License and Registration
Repairs, Oil, Tires
Page 6 of 14
b3100711-5193-405d-a0ca-b53305a04e4d.xls BUDGET 10/24/2011
BUDGET
Client Name: -
Nonmonthly Envelope
ITEM DESCRIPTION
Monthly Total Savings Total Actual Total
PERSONAL
Clothing
Dentist
Disability Insurance
Education
Entertainment
Furniture
Health Insurance
Life Insurance
Medical/Dental/Optical
Personal Care/Hair
MISCELLANEOUS
Bank Fees/Postage/Subscriptions
Blow Money
Child Care
Dry Cleaning/Laundry
Gifts
Pet Food/Pet Care
School Lunches
Toiletries
Tuition
Vacation
Other (specify _________________)
Other (specify _________________)
TOTAL MONTHLY EXPENSES - - - -
Page 7 of 14
b3100711-5193-405d-a0ca-b53305a04e4d.xls BUDGET 10/24/2011
SCHEDULE OF PAYMENTS
First Pay Second Third Pay Fourth
Client Name: Day Pay Day Day Pay Day
Monthly
ITEM DESCRIPTION
Total
$__.00 $__.00 $__.00 $__.00
GIVING
Charity
Church
Other
SAVINGS
Emergency Fund
Other
HOUSING
First Mortgage/Rent
Homeowner's Insurance
Property Taxes
Repairs/Upkeep
Second Mortgage
UTILITIES
Cell Phone
Internet
Natural Gas
Oil
Sewer
Telephone
Television (Cable/Satellite)
Trash
Water
FOOD
Eating Out
Groceries
TRANSPORTATION
Car Insurance
Car Payment
Gasoline/Diesel
License and Registration
Repairs, Oil, Tires
Page of Payments
b3100711-5193-405d-a0ca-b53305a04e4d.xls Schedule8 of 14 10/24/2011
SCHEDULE OF PAYMENTS
First Pay Second Third Pay Fourth
Client Name: Day Pay Day Day Pay Day
Monthly
ITEM DESCRIPTION
Total
$__.00 $__.00 $__.00 $__.00
PERSONAL
Clothing
Dentist
Disability Insurance
Education
Entertainment
Furniture
Health Insurance
Life Insurance
Medical/Dental/Optical
Personal Care/Hair
MISCELLANEOUS
Bank Fees/Postage/Subscriptions
Blow Money
Child Care
Dry Cleaning/Laundry
Gifts
Pet Food/Pet Care
School Lunches
Toiletries
Tuition
Vacation
Other (specify _________________)
Other (specify _________________)
Debt Snowball
TOTAL MONTHLY EXPENSES
Page of Payments
b3100711-5193-405d-a0ca-b53305a04e4d.xls Schedule9 of 14 10/24/2011
DEBT SNOWBALL
Client Name: -
Net Disposable Income: -
Total New Payments Cumulative
ITEM DESCRIPTION Total Payoff
Payment Payment Remaining Payments
TOTAL: - -
Page
b3100711-5193-405d-a0ca-b53305a04e4d.xls DEBT 10 of 14 10/24/2011
PRO RATA PLAN
Client Name:
Total Disposable New
ITEM Total Debt Percent
Payoff Income Payments
TOTALS
Page 11
Client - b3100711-5193-405d-a0ca-b53305a04e4d.xls 10/24/2011
Follow-Up
Client Name: 0
Page 12
b3100711-5193-405d-a0ca-b53305a04e4d.xls Follow-Up of 14 10/24/2011
Follow-Up
Client Name: 0
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b3100711-5193-405d-a0ca-b53305a04e4d.xls Follow-Up (2) 14 10/24/2011
Follow-Up
Client Name: 0
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b3100711-5193-405d-a0ca-b53305a04e4d.xls Follow-Up (3) 14 10/24/2011