Budget Worksheet

Fields marked with a * are required.

I. Contact Information


II. Income Information

Gross Monthly Amount

Net Monthly Amount

Totals


III. Monthly Income and Expense Record

Enter Monthly amounts, not Annual

Expense

Monthly Payment

1st Mortgage/Rent

2nd Mortgage

Property Taxes (if not included in mortgage)

Homeowner's Insurance (if not included in mortgage)

Association Dues

Energy (gas/oil/electric)

Water/Sewage

Phone/Cell Phone

Home Maintenance

Life Insurance

Car Insurance

Student Loan Debt

Car Loan

Car Repair/Maintenance

Food/groceries/fast food/restaurant

Gasoline/transporation/parking

Medical (doctor, dentist, eye care, prescriptions)

Daycare, babysitters

Cable TV/Internet

Educational expenses (including tuition and books)

Church/religious donations

Personal (hair, clothes)

Cigarettes/beverages (including alcohol)

Christmas/Gifts

Entertainment/Hobbies/Sports

Other Expenses

Total Monthly Expenses


Total Monthly Income

Deduct Monthly Expenses from Income


IV. Debt Analysis

Please complete the debt information. You should include all consumer debts. Include the issuing bank for all Visa and Mastercard debts.

Example:

Creditor/Collection Agency

Balance

Payment

ABC Collection
Allied Collection
Chase
Bonton

3000
4000
2500
350

0
200
25
10

Creditor/Collection Agency

Balance

Payment

Total Outstanding Balance

If you choose our debt management plan (DMP), your payment could be



Enter the answer in the box as a number. What is fifteen minus seven?

Help Text

Click the Submit button when finished. If you do not see the "Success" message, please check to see that you have completed all of the required items.
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