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Age:

Mortgage Balance
Mortgage Payment
Interest Rate	%
Years Left on Mortgage
2nd Mortgage/Home Equity Line Balance
Interest Rate	%
Credit Card Balance 1
Interest Rate	%
Car Loan Balance 1
Interest Rate	%
Car Loan Balance 2
Interest Rate	%
Consumer Loans (Appliances, TV’s, Etc
Interest Rate	%
Boats/ATVs/RVs
Interest Rate	%
Paying Additional Principle Toward Loans?	Yes No

Gross Annual Income (What's your annual salary before taxes and other expenses. For hourly, take your hourly pay rate and multiply by 2000 hours. This will be your annual gross income.)
Total Monthly Expenses (Include Household Bills, Groceries, Utilities, Phone & Internet, Car, Life & Health Insurance, Mortgage and loan payments)
Amount Saved Each Month
Number of Teenage Children Between (12-18)
Total College Savings (lump sum)

Money In Savings
Other Cash/Investment Reserves
Pre Tax Retirement Accounts (401k, IRA, Mutual Funds)
Post Tax Retirement (Cash Value Life Insurance-Roth IRA)
Other Monthly Investment Income (Real Estate,Business Income)

Late On Payments	Yes No
$1000 Liquid Cash Emergency Fund	Yes No
Life Insurance (burial expenses for primary breadwinner)	Yes No
Long Term Care Insurance	Yes No