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Name
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First
Last
Email
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Age
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Occupation
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Spouse's Name
Spouse's Age
Spouse's Occupation
Income
What is your total annual income?
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What is your average monthly take home pay? (pay after earnings)
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Do you have a budget?
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If yes, what budgeting platform do you use?
Do you know your total net worth? If so please list it here.
Debt
For this section please list the total balances due as well as the monthly payment for each type of debt. Please leave the answer(s) blank if you do not have any debt for a specific debt type.
Federal Student Loans
Private Student Loans
Credit Cards 0% Interest
Credit Cards 1+% Interest
Buy Now/Pay Later Loan
Car Debt
401k loan or Life Insurance Loan
Personal Loan
Medical Debt
Business Debt
Utility Loan (Solar, Internet, Phone/Tablet)
Utility Loan (Solar, Internet, Phone/Tablet) (copy)
Debt to friends or family
HELOC
Mortgage/Land
I have additional debt not listed in the options above
Are you paying over the minimum amount on any of your debts? If so, which one’s?
Section Divider
How much is in your emergency fund?
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If you are currently saving for an emergency fund, how much are you saving?
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Retirement/Investing
On average, how much are you saving and investing each month?
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How much do you have currently invested?
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Out of that sum, how much is for retirement?
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Real Estate
Do you own or rent your primary residence?
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How much is your rent/housing payment?
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Do you own any properties outside of your primary residence?
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Final Questions
Why did you decide to sign up for coaching today?
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Anything you’d like us to know about before your first session?
What would you consider to be your biggest financial issue?
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Have you taken Caleb’s budgeting course or a course like it?
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