First Name

Last Name

Email *

Phone *

Date of birth

Do you track your income and expenses with a budget currently? *

Yes

No

Do you set aside money for either savings or investments every paycheck? *

Yes

No

How many months of expenses do you have saved? *

None

Less than 1 month

1–3 months

3–6 months

6+ months

Do you have separate savings buckets for emergency, sinking funds, long-term? *

Yes

No

Do you carry balances on either credit cards or personal loans? *

Yes

No

What percentage of your income goes toward repaying debt monthly? *

Less than 10%

10–25%

25–50%

More than 50%

Do you know your credit score range? *

Below 580

580–669

670–739

740+

Do you contribute to retirement accounts (401k, IRA, etc.)? *

Yes

No

Do you have coverage on life insurance outside of work? *

Yes

No

Do you have a retirement savings target or goals? *

Yes

No

Do you have these in place (will, trust, or estate plan)? *

Yes

No

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