..

SECTION 1

STEP 1 : In this step we will gather some important information about you. The information you provide will be used to your benefit. Be as specific as possible.
Referred from *
Your name *
Do you work?*
Your age *   format: ##
Spouse name
Does your spouse work?
Address *
City *
State *
Zip *
Telephone *  format: ### ###-####
e-mail *
Housing status *
Annual income *
Your education level *

 

SECTION 2

STEP 2 : In this step we will gather some important information about your monthly incomes. Please enter all recurring incomes that your household receives.

NOTE: Enter amounts in whole dollars only.

INCOMES

(Enter monthly amounts only.)

Personal income $   Military $  
Spouse income $   Annuity $  
Part time income $   Alimony/Child support $  
Social Security $   Food stamps $  
Retirement $   Disability $  
Pension $   SIS disability $  
Other $  

 

SECTION 3

(Enter monthly amounts only.)

STEP 3 : Budget Investigator will now take a look at all the recurring monthly expenses that you have.  The expenses are broke into four  broad categories. After the submission of the information Budget Helper will further redefine the expenses into other categories as well.

NOTE: Enter amounts in whole dollars only.

HOUSEHOLD

(Enter monthly amounts only.)

Rent/Mortgage $   Clothing $  
Taxes $   Church $  
Car payments $   Dry cleaning $  
Union dues $   Gifts $  
Alimony/Child Support $   Investments $  
Transportation $   Auto gas $  
Groceries $   Doctor/Prescription $  
Day care $   Miscellaneous $  
Education $  

UTILITIES

(Enter monthly amounts only.)

Natural gas/Propane $   Water/Sewer/Trash $  
Electric $   Cable $  
Telephone $  

INSURANCE

(Enter monthly amounts only.)

Life $   Medical

$

          
Auto $   Home

$

 

REVOLVING DEBTS

(Enter monthly amounts only.)

Credit cards $   Installment loans $  
Personal loans $   Other secured loans $  

 

SECTION 4

 

STEP 4 : You are at the final step of the Budget Helper budget review. Select the response that most closely describes your household situation. Please rate the statements from 1 - 5, with 1 being "NO" and 5 being "YES." Your answers will help us evaluate your current situation.

 

1. I have established financial goals and have developed a plan to achieve these goals.

NO   YES
1 2 3 4 5

 

2. I have tracked my household expenses for at least 30 days and am aware of my spending habits.

NO   YES
1 2 3 4 5

 

3. My family and I agree on the manner in which our money is managed.

NO   YES
1 2 3 4 5

 

4. I am meeting my household expenses without difficulty.

NO   YES
1 2 3 4 5

 

5. My bills are paid on time.

NO   YES
1 2 3 4 5

 

6. I am current with my mortgage/rent payment.

NO   YES
1 2 3 4 5

 

7. I know the total amount of my unsecured debt.

NO   YES
1 2 3 4 5

 

8. I am comfortable with the total amount of my unsecured debt.

NO   YES
1 2 3 4 5

 

9. I am current in all payments on unsecured debt.

NO   YES
1 2 3 4 5

 

10. I know what the causes of my financial difficulties are.

NO   YES
1 2 3 4 5

 

11. I have spoken with my creditors to negotiate a reduced payment plan.

NO   YES
1 2 3 4 5

 

12. I have found budgeting to restrictive and difficult.

NO   YES
1 2 3 4 5
Congratulations, you have reached the end of the data entry phase. Please review ALL entered information for correctness. Make any final changes as needed. The final step in the process is to enter a referral source and number, if you were provided with one. 

If all the information is correct press the Submit button.

 

 

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