New Client Information Sheet
Date:
Name: ________________Social Security # ______________
Address: _______________City:
Telephone: Home __________Work_________ Zip_____
Employers Name and Hourly/monthly/annual salary:
Name of Spouse: ___________Social Sec. # ______________
Spouse's Employer: _________Telephone:
Spouse’s pay ______________Client Email address
PLEASE FILL OUT COMPLETELY, estimate amounts if you are not sure
Real Estate owned: Address:
Mtg. Co. Payoff mo pmt value months now due
1st mtg
2nd mtg
Do you own any other real estate?
Have you made any lump sum payments toward any real estate or toward any mortgage in the last 10 years? If so state where the money came from, when it was paid, and the amount paid.
Automobiles, boats, 4 wheelers, etc., whether you owe on them or not
Yr/Make/Model Lienholder Bal Due Mo pymt Mileage Value Arrear
1st veh
2nd veh
3rd veh.
Have you given any creditors a list of your furniture when you borrowed money from them? If so, list these creditors:
Have you financed any furniture, electronics, jewelry or appliances through any creditors that you still owe money to?
Do you owe any money to IRS___Alimony__Child Support___ or Student Loans___
Have you filed all tax returns through 2005___ Did you get a refund or owe?____ how much? $_________
Do you owe any Taxes now? Amount ____ for year _______
List major unsecured debts: (estimate amounts owed)
When is the last time you charged on any credit cards or took a cash advance?____
Approximately how much total have you charged, including all balance transfers or cash advances, in the last 6 months?$_______
List the names of all creditor to whom you owe money and the estimated amount you owe
Has anyone obtained any civil or criminal judgments against you? If so, list here and bring a copy of them to the meeting.
Do you owe any money to relatives or friends now?___ If so how much $______
Have you repaid any relatives or friends more than $500 in the last year? If so who and how much?
Have you made any gifts to anyone over $500 in the last year? If so to who and how much?
Have you transferred anything out of your name to anyone else worth more than $500 in the last year? if so what and to whom?
Are you suing anyone, or do you have the right to sue anyone?
If you have any type of pension, retirement plan, profit sharing plan, stock option plan, or annuity: put down name and approximate amount of money in plan here:
Other than furniture, clothes & jewelry, do you have anything else worth over $250.00
Estimate the garage sale value of your furniture, household goods, clothing, and jewelry: ie what you would get if you sold it all at a garage sale one weekend $___________
Have you received over $4,000 from any life insurance, inheritance, lawsuit settlement, cashed in retirement fund, sale of property, or other source other than regular monthly income within the last 10 years? If so describe date, source of funds, and where funds were spent.
Where did you hear about this office?