Coaching – Intake Waitlist – DollarWise Central

Shoot! Looks like we sold out... We will be opening more spots soon! Fill out this intake form if you'd like to be considered when spots are available.

Fill out this brief Application

Name

First

Last

Age

Occupation

Spouse's Name

Spouse's Age

Spouse's Occupation

Income

What is your total annual income?

What is your average monthly take home pay? (pay after earnings)

Do you have a budget?

If yes, what budgeting platform do you use?

Do you know your total net worth? If so please list it here.

Debt

For this section please list the total balances due as well as the monthly payment for each type of debt. Please leave the answer(s) blank if you do not have any debt for a specific debt type.

Federal Student Loans

Private Student Loans

Credit Cards 0% Interest

Credit Cards 1+% Interest

Buy Now/Pay Later Loan

Car Debt

401k loan or Life Insurance Loan

Personal Loan

Medical Debt

Business Debt

Utility Loan (Solar, Internet, Phone/Tablet)

Utility Loan (Solar, Internet, Phone/Tablet) (copy)

Debt to friends or family

HELOC

Mortgage/Land

I have additional debt not listed in the options above

Are you paying over the minimum amount on any of your debts? If so, which one’s?

Section Divider

How much is in your emergency fund?

If you are currently saving for an emergency fund, how much are you saving?

Retirement/Investing

On average, how much are you saving and investing each month?

How much do you have currently invested?

Out of that sum, how much is for retirement?

Real Estate

Do you own or rent your primary residence?

How much is your rent/housing payment?

Do you own any properties outside of your primary residence?

Final Questions

Why did you decide to sign up for coaching today?

Anything you’d like us to know about before your first session?

What would you consider to be your biggest financial issue?

Have you taken Caleb’s budgeting course or a course like it?