Basic Information First Name Last Name Email Address Phone Number Monthly Take Home Income Salary/Wages/Business Draw Salary or Wages (Spouse) Social Security Pension/Retirement Interest on Accounts Alimony / Child Support Real Estate rent (income) Investment Dividends Unemployment/ Food Stamps Other Total Income: $0 Monthly Living Expenses Alimony / Child Support (outgoing) Auto Gas and Repair Auto Insurance Cable TV/ Satellite Fees Charitable Contributions Child Care Childrens' Activities Clothing Maintenance (Laundry/Dry cleaning) Clothing Purchases Electric Bill Food (In-home / Groceries) Food (Out of home - Lunch, Dining) Gas and Oil Bill Health and Dental Insurance Homeowner/Condo fees Homeowners/ Renters Insurance Household items Internet Access (AOL, MSN, DSL) Life and Disability Insurance Memberships (Health club etc.) Personal Care (Grooming) Prescriptions Property Services (Gardener, Pool) Security Services (Alarm) Subscriptions Telephone/Cellphone Trash Disposal Tuition and School Supplies Water Bill Other Expenses 1 Other Expenses 2 Other Expenses 3 Total Living Expenses: $0 Secured Debts (Monthly Payments) Rent 1st Mortgage 2nd Mortgage Land Lease (Trailer park, other) Student Loans Auto Loans/Leases Recreation (Boat, ATV, etc.) Past Due Taxes Other Debts Other Debts Other Loans Other Loans Total Secured Debts: $0 Unsecured Debt Credit Card 1 Credit Card 2 Credit Card 3 Credit Card 4 Credit Card 5 Credit Card 6 Credit Card 7 Credit Card 8 Personal Loan 1 Personal Loan 2 Medical Bill Payment Other 1 Other 2 Total Unsecured Debts: $0 Total Disposable Income: $0 Δ