Shawn R. Perkins
Financial Strategist
Shawn R. Perkins
Mortgage & Financial Strategist
(619) 994-1110
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The Fiscal Facilitator Web Form
The purpose of this form is to help you in gathering the basic information about your current financial situationnwhich we will need in order to make the best use of our time together. Knowing the information requested in this form will help me identify areas of financial vulnerability in your personal financial profile. The information in this form will provide us a framework with which to discuss options for reducing or eliminating these vulnerabilities. Please fill out the form and answer the questions to the best of your ability. All information provided will be strictly confidential.
Step 1 of 6
16%
A. Family Information
Your Full Name
Date of Birth
MM
DD
YYYY
Mobile Phone (You)
Email (You)
Credit Score (You)
Spouse Information
Spouse Full Name
Spouse Date of Birth
MM
DD
YYYY
Mobile Phone (Spouse)
Email (Spouse)
Credit Score (Spouse)
Primary Residence Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Own/Rent/Live with Parents?
Own
Rent
Live w/Parents
Monthly Rent or Mortgage Payment
Martial Status
Children
Yes
No
Health Insurance
Yes
No
B. Income Information
Your Gross Employment Income
Other Income*
*(include spousal support Income, child support income, trust fund income, retirement income, 2nd job, etc…)
Desired Retirement Age
Are you entitled to a Pension?
Yes
No
Spouse Employment Information
Spouse Gross Employment Income
Other Income*
*(include spousal support Income, child support income, trust fund income, retirement income, 2nd job, etc…)
Spouse Desired Retirement Age
Is spouse entitled to a pension?
Yes
No
C. Real Estate/Mortgages
List Your 1st Mortgage, 2nd Mortgage (HELOC) & 2nd Home
Residence Type*
Current Market Value (Estimate)
Current Loan Balance
Interest Rate (%)
Term in Years
Minimimum Total Monthly Payment
Actual Payment Sent To Lender
HOA Dues
*(Under Residence Type, List whether it is a 1st or 2nd Mortgage and/or 2nd Home)
D. Savings & Taxable Investments
Investments List
Investment Type/Name*
Current Account Balance
Annual Contributions or Withdrawals
Account Owner
*(include checking accounts, savings accounts, money market accounts, securities, mutual funds, annuities, etc.)
E. Qualified Retirement Accounts
Account List
Investment Type/Name*
Current Account Balance
Annual Contributions or Withdrawals
Company Match: Yes or No?
Account Owner
*(IRA, 401K, 403b, Thirft Savings Plan, KEOGH, etc.)
F. Installment Loans
Loans List
Type of Loan*
Loan Unpaid Balance
Interest Rate (%)
Months Remaining
Minimum Monthly Payment
Amount Sent to Lender
*(Include auto, RV, trailer, toy hauler, ATV, watercraft, personal, student, etc. Do not list credit cards.)
G. Credit Card Accounts
Account Listing
Type of Account*
Account Limit
Current Unpaid Balance
Interest Rate (%)
Minimum Monthly Payment
Amount Sent to Lender
*(include credit cards, charge cards, department store cards, etc.)
H. Estate Information
Do you have Life Insurance?
Yes
No
Face Value
Insurance Type
Term
Permanent
Cash Value
Spouse Life Insurance
Does your Spouse have Life Insurance?
Yes
No
Face Value
Insurance Type
Term
Permanent
Cash Value
Wills & Trust
Do you have a Will?
Yes
No
Do you have a Trust?
Yes
No
Do you have Healthcare Directives?
Yes
No
Do you have Powers of Attorney?
Yes
No
I. Additional Information
Child College Philosophy
Parent to pay in full
Parent to assist (%)
Child's responsibility
Please provide the % in the next field.
% of Assistance
Please enter a number less than or equal to
100
.
Child Wedding Philosophy
Parent to pay in full
Parent to assist (%)
Child's responsibility
Please provide the % in the next field.
% of Assistance
Please enter a number less than or equal to
100
.
Child Transportation Philosophy
Parent to pay in full
Parent to assist (%)
Child's responsibility
Please provide the % in the next field.
% of Assistance
Please enter a number less than or equal to
100
.
What other factors could be important to your financial position?*
*(Bankruptcy, Short Sale, Foreclosure, Spousal Support Obligation, Child Support Obligation, Tax Liens, Judgments, Other Liens, Credit Counseling, Inheritance, etc.)
Was this form easy to fill out?
Yes
No
Additional Information or Comments?
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Our clients consistently reach financial success by following our processes to avoid costly mistakes and reach sound fiscal health.
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