Debts

First name

Last name

Email

Phone

LIST SECURED DEBTS (mortgages, car loans, furniture, jewelry, appliances, electronics)

HOME: Property Address

Market Value: $

1st TD: Lender

2nd TD: Lender

Property Tax

Balance: $

Monthly Payment $

Number of Months Behind

HOA Fees

Balance: $

Monthly Payment $

Number of Months Behind

VEHICLE LOANS (Auto, Truck, Motorcycle, Motor Home, RV, Boats, ATV, Jet Ski, ect)

Yr/Make/Model

FURNITURE, APPLIANCES, ELECTRONIC GOODS, COMPUTER, JEWELRY, OTHER

Item(s)

Do You Have Any Co-Signors or Guarantors?

Yes

No

Are You A Co-Signor or Guarantors?

Yes

No

UNSECURED DEBTS - List all debts that you owe money, even if you are uncertain, deleted, written off. Include all credit cards with balances owing, charge accounts, medical, dental, hospital bills, personal loans, bad checks, auto accidents, lawsuits:

Creditor Name / Type of Debt / $ per Month / $ Balance / Number of Months Behind

I swear to complete this client worksheet to the best of my abilities and to tell the truth under penalty of perjury:

Signature field is empty.

Signature

CLIENT INTAKE WORKSHEET

PRELIMINARY CLIENT INFORMATION

Debts