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					                                      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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                                              Page 1
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls Instructions of 14                             9/8/2011
                     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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                                              Page
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls Priorities 2 of 14                        9/8/2011
                     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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                                             Page 3
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls Preparation of 14                                        9/8/2011
                                     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
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls INCOME-SUMMARY                                       9/8/2011
                                          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                               -                  -          -


                                            Page
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls EQUITY 5 of 14                       9/8/2011
                                             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




84fe0ce7-f475-48c2-9290-4e61d62e8663.xls BUDGETPage 6 of 14                                     9/8/2011
                                             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                               -            -           -                -




84fe0ce7-f475-48c2-9290-4e61d62e8663.xls BUDGETPage 7 of 14                                     9/8/2011
                          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 8 Payments
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls Schedule of of 14                                   9/8/2011
                          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 9 Payments
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls Schedule of of 14                                   9/8/2011
                                  DEBT SNOWBALL

                   Client Name:             -
          Net Disposable Income:                -
                                                      Total       New     Payments Cumulative
         ITEM DESCRIPTION            Total Payoff
                                                    Payment     Payment   Remaining Payments




  TOTAL:                                        -           -




                                            Page 10 of 14
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls DEBT                                            9/8/2011
                                    PRO RATA PLAN
                   Client Name:
                                        Total                           Disposable     New
                ITEM                               Total Debt Percent
                                        Payoff                            Income     Payments




              TOTALS




Client - 84fe0ce7-f475-48c2-9290-4e61d62e8663.xlsPage 11                                9/8/2011
                                            Follow-Up

                   Client Name:         0




                                             Page
84fe0ce7-f475-48c2-9290-4e61d62e8663.xls Follow-Up12 of 14   9/8/2011
                                            Follow-Up

                    Client Name:        0




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84fe0ce7-f475-48c2-9290-4e61d62e8663.xls Follow-Up13 of 14   9/8/2011
                                            Follow-Up

                    Client Name:        0




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84fe0ce7-f475-48c2-9290-4e61d62e8663.xls Follow-Up14 of 14   9/8/2011

				
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