Debt

Assets

Is your debt manageable

Are you often late in paying your bills?

Yes No

Do unexpected expenses cause financial stress for your monthly planning of paying bills?

Yes No

Do you often worry about paying your bills on time?

Yes No

Do you find you need to borrow money from friends/family/pension plan to make payments?

Yes No

Have your borrowed from your pension plan in the last 12 months?

Yes No

Are you behind on any of your credit card payments?

Yes No

Are you behind on your mortgage payment?

Yes No

Are you behind on your car payment?

Yes No

Is your bank account restrained?

Yes No

Are you being garnished?

Yes No

Are creditors calling you?

Yes No

Are you able to make more than minimum payments on your credit cards?

Yes No

Has your car been repossessed?

Yes No

Do you owe back taxes?

Yes No

Are you using credit cards to pay off other credit cards

Yes No

Do you move balances from one credit card to another to reduce payments?

Yes No

Has your income decreased within the last six months?

Yes No

Have you or your spouse lost your job?

Yes No

Do  you regularly charge for small items such as food, transit rides, toiletries?

Yes No

Do you have extra money to provide to your kids such as lunch money, going to the movies, etc.?

Yes No

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Personal Information