1. What are the best ways to stay in touch with you? (check all that apply)
Email
Home Phone
Direct Mail
Cell Phone
Work Phone
2. Who is the primary point of contact in your household?
  
3. 
What are the top 3-5 objectives you would like to discuss with your Mortgage Planner?
#1   
#2   
#3   
#4   
#5   
4. 
Do you have any pending financial expenses or obligations that must be addressed during your initial consultation? (paying off debt, college expenses, new car, home improvements, life style change, medical expenses, etc.)
#1   
#2   
#3   
#4   
5. 
Of the following financial goals, which are priorities for you right now? (check all that apply)
Improve monthly cash flow
Maximize retirement savings
Maximize education savings
Live on one income
Create a comprehensive financial plan
Create a larger (6-12 mos income) emergency reserve account
Maximize investment contributions
Maximize asset portfolio performance
Real Estate investment
Pay off non-preferred debt
Other
  (Describe Other Goals)
6. 
On a scale from 1-10 (10 being the best), please rate your current level of satisfaction in the following areas:
  Household Budgeting and monthly cash flow
  Debt Management
  Retirement Planning
  College Savings/Planning
  Emergency cash reserve fund
  Estate Planning, wills and trusts
  Life insurance needs (wealth and family protection)
  Tax planning
7. 
What is your estimated retirement age?
  Partner #1
  Partner #2
8. In respects to your retirement planning, do you feel you are:
Ahead of where you need to be
On par with where you need to be
Behind on where you need to be
9. How much are you currently contributing towards your retirement objectives monthly?
  
10. 
What percent, if any does your company match on your 401K contributions?
  Partner #1
  Partner #2
11. What is your desired net monthly income, (today's dollars), at retirement?
  
12. How much additional could you set aside monthly for retirement?
  
13. 
Which of the following are the most important to you regarding your mortgage financing? (select all that apply)
Determine the maximum purchase price and loan amount I qualify for
Determine purchase price and loan amount appropriate for my income and lifestyle
Utilize efficient equity management strategies in my refinance decision
Obtain a targeted monthly mortgage payment
  (target amount)
Purchase a home within a specific price range
Have the choice to sell, paydown, or refinance home without penalty
Qualify for new home prior to or without sale of existing home
Other
  (Describe other)
14. 
Do you have life insurance?
Yes
No
Face Amount/Death Benefit?
  Partner #1
  Partner #2
What Type?
Term
Whole Life
Other
  (Describe Other)
15. 
Do you have a financial planner/money manager?
Yes
No
How do you rate your satisfaction with their performance?   
16. 
Do you have a CPA?
Yes
No
How do you rate your satisfaction with their performance?   
17. 
Do you have a trusted Real Estate Advisor?
Yes
No
How do you rate your satisfaction with their performance?   
18. 
Do you have children?
Yes
No
How Many?   
What are their ages?   
Do you have a college funding strategy currently in place for your children?
Yes
No
19. Would you be interested in information about wealth building strategies?
Yes
No
20. Do you have interest in purchasing Real Estate for investment purposes sometime in the future?
Yes
No
21. Do you have any other questions for me about the Mortgage Planning process or Loan Process?