Budget Form Information Step 1 of 13 - Let's Get Started! 0% OK! Let's get you on financial track! The next few pages of this form will take you through your entire financial situation. This is all information I need to provide the most accurate plan for you! Note: you do have the option of saving your progress along the way. To complete the form, you will need: Your most recent pay stub Your monthly bill amounts and due dates Your current debt amounts and interest rates, and applicable information Your current financial goals and priorities. Note: All of the information entered in the form is completely secure, not shared with anyone outside of City Girl Savings, and we do not ask for any personal information outside of payment. Feel free to reach out to us at any time during the process if you need help or support at contact@citygirlsavings.com What best describes your current monthly financial situation?* Living paycheck to paycheck (not saving) After all expenses and purchases, saving a little After all expenses and purchases, saving a lot Unable to afford all of my expenses, too much debt What is your current financial need?* I need to save I need to shop I need to pay off debt/loans/bills I need to make more money to afford all of my expenses Based on your selected financial need, your goal is to...Save -- Is this correct? Yes No Shop -- Is this correct? Yes No Pay Off Debts -- Is this correct? Yes No Need Assistance Allocating Income Appropriately -- Is this correct? Yes No Save - Specify* Saving for a goal purchase? (ex: new shoes, new home, new apartment, purse, etc) Saving for a goal amount? (ex: $5000) Saving for a specific deadline? (ex: I need $1000 by January 1st) Specify your goal amount Specify your goal purchase Shop - Specify* Shopping for a particular item? Shopping to upgrade your lifestyle? (ex: received a raise, need to spoil yourself) Specify what you're shopping for Pay Off Debts - Specify* Loan/Bill/Debt is due by a specific date? Paying off debts to restore credit? Paying off debts to start a savings? Let City Girl Savings provide a budget that allows for shopping and some saving!Let City Girl Savings provide you with a budget that allows you to start saving!Let City Girl Savings provide you with a budget that allows you to start saving!Let City Girl Savings provide you with a budget that allows you to start saving!Let City Girl Savings provide you with a budget that allows you to take care of your debt!Let City Girl Savings provide you with a budget that allows you to take care of your debt!Let City Girl Savings provide you with a budget that allows you to take care of your debt!Let City Girl Savings help you get on financial track!Select a GoalSaveShopPay Off DebtsNeed Assistance Allocating Income AppropriatelyNone of the aboveSpecify a GoalIf none of the above goals fit what you are looking for, please describe the financial goal you are looking to achieve. NOTE: Initial budgets provided are for a maximum one year goal date. This allows the customer to focus on a date not too far away. Once your first financial goal is met, you will have the option of extending or creating a new budget based on a different financial goal.Target Goal Date* 1 – 3 months 3 – 6 months 6 – 9 months 9 – 12 months Other Specify Target Goal Date*Your target date must be 12 months or less away from your budget start date. MM slash DD slash YYYY OK! Looks like we have a specific goal and target date set! Let’s get your financial information. Income Please try to be as accurate as possible to ensure the best results. Use the "+" button to add more items under each section (if applicable).Job Profession* Start / Hire Date* MM slash DD slash YYYY Annual Salary (Gross)*Pay Period* 1st & 15th Bi-weekly Weekly Monthly Commission only Next Pay Date* MM slash DD slash YYYY Gross Amount (per check)*Net Amount - Take Home Pay (per check)*Paycheck Deductions*Insurance401kOtherPaycheck Taxes*Federal TaxesState TaxesOtherUpload Your Pay stubDon't want to enter the information above? Simply put 0 in the fields and upload your pay stub.Max. file size: 2 MB.Bonus or Commission?*If your bonus or commission is not consistent, please provide an average amount based on what was received the past year. Enter that amount under the Average Annual Amount section.Bonus AmountConsistencyAverage Annual Amount Any Additional Income (Second Job, Hobbies, etc)* Yes Yes, but not consistent No Additional Income - ConsistentJob ProfessionStart DateAnnual SalaryPay PeriodNext Pay DateGross Amount (per check)Net AmountPay DeductionsBonus or Commission Additional Income - InconsistentHow often?How much?Last time received Expenses Use your monthly expense amounts. Please try to be as accurate as possible to ensure the best results. Use the "+" button to add more items under each section (if applicable).Rent/Mortgage*AmountDue Date Utilities*Water AmountDue Date Utilities*Power/Electricity AmountDue Date Utilities*Trash & Sewage AmountDue Date Utilities*Gas AmountDue Date Transportation*Gas AmountDue Date Transportation*Auto InsuranceDue Date Transportation*Parking/Public Transportation Monthly Expenses*HOADue Date Insurance - Home*Insurance - Life*Insurance - Disability*Insurance – Health (Leave blank if deducted from pay check)*Groceries*Dining & Meals Out*School/Workplace Lunches*Monthly Expenses*Cable, Phone, InternetDue Date Monthly Expenses*Cell PhoneDue Date Entertainment & Activities*Grooming & Cosmetics*Shopping*Subscriptions/Membership Fees*Please include bank fees, gym dues, subscriptions, etc.TypeAmountDue Date Miscellaneous/Other Reoccurring Expenses*Please include any other reoccurring expenses (medical, tuition, pet care, childcare, alimony, child support, senior care, tithing, charity, etc.)TypeAmountDue Date Debts & Liabilities Use your monthly debt amounts. Please try to be as accurate as possible to ensure the best results. Use the "+" button to add more items under each section (if applicable).Credit Card Debt*CreditorOutstanding BalanceAvailable CreditInterest RatePayment Due DateMinimum Payment Amount Car Payment*Dealer/FinancerOutstanding BalanceMonthly Payment AmountInterest RatePayment Due DateLoan Maturity DateLoan Start Date Loan*Type of LoanOutstanding BalanceMonthly Payment AmountInterest RatePayment Due DateLoan Maturity DateLoan Start Date Mortgage*FinancerOutstanding BalanceInterest RatePayment Due DateLoan TermLoan Start Date Upload Your StatementsDon't know your information, or don't want to enter in each item? Upload your statements and we'll figure it out! Please remove any account numbers or sensitive information prior to uploading.Max. file size: 2 MB. Assets Use your current asset amounts. Please try to be as accurate as possible to ensure the best results. Use the "+" button to add more items under each section (if applicable).Checking Accounts*Bank NameAmountMonthly Fees Savings*Bank NameAmountMonthly Fees Investment*(excludes 401k)Brokerage NameAmountMonthly Fees Other Accounts*Name / TypeAmountMonthly Fees 401k Amount*Are you willing to close/open accounts? Yes No Would you like to utilize the amounts in any of the accounts for your Budget?* Yes No Specify which accounts and amounts you would like to use*Bank NameAccount TypeAmount to use Would you like to start from scratch?NOTE: Select this option if you would like to form a budget based on your current income and expenses, and not with any of your current savings. Depending on financial situation, this may not be an applicable option. Yes No You're almost done!Are there any additional comments you would like Raya (CGS Finance Coach) to know before completing your plan (Specify)Option for Budget* Weekly Bi-Weekly Based on Pay Period Monthly So What Happens Next?Once your financial information has been submitted, you will receive an email confirming that your information has been received and your payment has been processed. Within 2-3 business days, you will receive an email from Raya advising you of any outstanding items that need to be addressed. Once those items have been addressed, or there were no further questions, Raya will begin working on your budget. The estimated completion date will range from 5-7 business days. You will receive your budget in email form, as well as printed form (if this option was selected). You are almost done! Just a few more details!Name* First Last Email Address Please hit "Submit" to finish your order Thank you for choosing City Girl Savings to help get you on financial track! 23502
