Confidential Financial Questionnaire - Federal Student Loan Debt Repayment and Option Help

So, please do yourself a favor and help me as well. First, complete the simple questionnaire below. Then click Submit to send it to me. Your answers will determine if I can help you.

Name

First

Last

Email Address

How Long in Nevada?

Prior Bankruptcy?

Would you like to add the 2nd person's information as Person 2?

Yes
No

Person 2 Name

First

Last

Person 2 Email Address

How Long in Nevada? (person 2)

Prior Bankruptcy? (Person 2)

Please enter the name of the employer

Wages

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Disability

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Unemployment

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Social Security

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Child Support

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Alimony

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Rental/Roommate Income

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Investment Income

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Student Loan Income

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Retirement Income

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Please enter the name of the employer for person 2

Wages (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Disability (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Unemployment (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Social Security (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Child Support (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Alimony (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Rental/Roommate (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Investment Income (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Student Loan Income (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Retirement Income (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Gambling Income (person 2)

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Gambling Income

Gross Amount

(before tax & insurance)

Take Home

(after tax and insurance)

Frequency

Home Mortgage

Yes
No

Balance

Monthly Payment Amount

Second Mortgage

Yes
No

Balance

Monthly Payment Amount

Solar or Home Repair/Maintenance expense

Yes
No

Balance

Monthly Payment Amount

Vehicle Loan 1

Yes
No

Balance

Monthly Payment Amount

Vehicle Loan 2

Yes
No

Balance

Monthly Payment Amount

Other Vehicle Loan or Vehicle Toys such as RV, ATV, boat, trailer.

Yes
No

Balance

Monthly Payment Amount

Tax Lien

Yes
No

Balance

Monthly Payment Amount

Judgment Lien

Yes
No

Balance

Monthly Payment Amount

Other Mortgage or Liens on Home

Yes
No

Balance

Monthly Payment Amount

Tax Debt

Yes
No

Estimated Balance

Monthly Payment Amount

Student Loans

Yes
No

Estimated Balance

Monthly Payment Amount

Other Loans

Yes
No

Estimated Balance

Monthly Payment Amount

Credit Cards

Yes
No

Estimated Balance

Monthly Payment Amount

Medical Debt

Yes
No

Estimated Balance

Monthly Payment Amount

Personal Loan(s)

Yes
No

Estimated Balance

Monthly Payment Amount

Business Loan(s)

Yes
No

Estimated Balance

Monthly Payment Amount

Business Debt(s) Guaranteed

Yes
No

Estimated Balance

Monthly Payment Amount

Lawsuit(s)

Yes
No

Estimated Balance

Monthly Payment Amount

Accident Claim against you

Yes
No

Estimated Balance

Monthly Payment Amount

Name

Name (2)

Name (3)

Name (4)

Age

Age (2)

Age (3)

Age (4)

Relation

Relation (2)

Relation (3)

Relation (4)

4. Rent or 1st mortgage

4B. Rental/Home Ins

4D. HOA

6A. Power & natural gas

Relation Frequency Other

6C. Phone, cell, internet, cable

7. Food/Groceries & HH exp

9. Clothes, laundry, dry cleaning

11. Medical & dental expenses

13. Rec & entertainment

15A. Life Insurance (not from pay)

15C. Vehicle Insurance

16. Taxes (not from wages)

17B. Vehicle payment 2

18. Student loans

20. Support to dependents

22. Other real estate expenses

24. Storage Unit

26. Cigarettes/Tobacco

28. Security System

30. Other un-reimbursed wk expenses

31B. Other expenses: Describe

4A. Property taxes

4C. Home repairs, upkeep

5. 2nd or 3rd Mortgage

6B. Trash, Water & sewer

6D. Other utilities: (Describe)

8. Childcare, Edu School Exp

10. Personal care products & services

12. Gas, oil, repairs (exc loan pmts)

14. Charitable contributions

15B. Health insurance (not from pay)

15D. Other insurance

17A. Vehicle payment 1

17C. Other installment Describe

19 Alimony/Child you pay

21. Other real estate expenses

23. Bank service charges

25. Pet care

27. Non-food purchases

29. Lunch at work

31. Other expenses: Describe

31C. Other expenses: Describe