Please fill out the “Financial Snapshot” form below to complete your registration. Name * First Name Last Name Age * Occupation * Spouse Name * First Name Last Name Age * Occupation * Have you been through FPU? * Yes No What's FPU? Number of children or other dependents * None 1 2 3 4 5 6 7 8 9 10 Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Preferred method of contact for your session * In person Phone Video conference What is your monthly NET income? * NET income = income received after the deduction of taxes, benefits, and voluntary contributions from a paycheck Do you have an irregular income? * Yes No Do you use a monthly budget? * Yes No Do you have an emergency fund? * Yes No How much is in the fund? * Are you currently investing for retirement? * Yes No What is your balance? * What is your monthly contribution? * Do you contribute to non-retirement savings? * Yes No What is your balance? * What is your monthly contribution? * Do you rent or own? * Rent Own Are you current on your payment? * Yes No What are the total monthly payments? * Do you have any vehicle loans? * Yes No Are you current on vehicle payments? * Yes No What are your total monthly payments? * List any Credit Card balance due * List any Student Loan balance due * List any Tax balance due * List any other debt balance due * What primary issue should we focus on during your coaching session? * Budgeting Real Estate Dealing with collectors Wealth building/Investing Debt Elimination Other List the top three concerns/questions related to your above selection: * Thank you! Michael will reach out soon to schedule your session.
