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Financial Questionnaire
 
Print, fill out, then fax to (614) 939-4705

General Financial InformationMonthly Personal Budget

Personal Financial StatementSchedule of Loans & Insurances

 

 

INCOME

 

Practice Draw

 

W-2 Income (Net of Taxes)

 

Other: ______________________

 

Other: ______________________

 

Total Income

$

   

EXPENSES

 

Automotive (gas, maintenance)

 

Child Care

 

Clothing

 

Contributions

 

Credit Card (Old Balances)

 

Entertainment

 

Food

 

Gifts

 

Home Maintenance

 

Home Mortgage

 

Insurance (from schedule)

 

Laundry

 

Loans (from schedule)

 

Medical

 

Miscellaneous

 

Personal Hygiene

 

Rent

 

Savings

 

Taxes (in arrears)

 

Telephone

 

Travel & Vacation

 

Utilities

 

Total Expenses

$

   

Income Less Expenses

$




Print, fill out, then fax to (614) 939-4705