Name(s) ______________________________ Loan #_____________________ Address___________________________________________________________ A. Household Expenses: B. Your Monthly Income: Fixed Monthly Expenses: Payment: Gross Income: Net Income (after taxes Rent payment and deductions): Gas $ $ Electric Heating Oil Water & Sewer Spouse or Income Telephone Partner’s Car Payment 1 Gross Income: Net Income (after taxes Car Payment 2 and deductions): Auto Insurance $ $ Life Insurance Medical Insurance Alimony / Child Support Alarm System Other Household Income: Property Taxes/Insurance Gross Income: Net Income (after Other/Minimum Credit Card taxes and deductions): Payment from Section C $ $ Sub-Total FIXED Describe: Expenses: Variable Monthly Payment Expenses C. Credit Cards and Other Debt: Groceries Creditor Name: Payment: Balance: Eating Out Gas Bus/Taxi/Parking Car Repairs Toiletries/Hair Care Medical Prescriptions Day Care Total $ $ Cable TV/Internet Clothing/Laundry D. Surplus/Deficit: Lottery $ Total Net Monthly Church/Charity Household Income: Entertainment Subtract Total Monthly $ Cell Phone Expenses: Other $ = Monthly Surplus or Deficit Sub-Total, VARIABLE Expenses: Total Monthly Expenses: Signature:__________________________ Date: ___________________________
Name(s) ______________________________ Loan #_____________________ Address___________________________________________________________ A. Household Expenses: Fixed Monthly Expenses: Payment: Rent payment Gas Electric Heating Oil Water & Sewer Telephone Car Payment 1 Car Payment 2 Auto Insurance Life Insurance Medical Insurance Alimony / Child Support Alarm System Property Taxes/Insurance Other/Minimum Credit Card Payment from Section C Sub-Total FIXED Expenses: Variable Monthly Expenses Payment Groceries Eating Out Gas Bus/Taxi/Parking Car Repairs Toiletries/Hair Care Medical Prescriptions Day Care Cable TV/Internet Clothing/Laundry Lottery Church/Charity Entertainment Cell Phone Other Sub-Total, VARIABLE Expenses: Total Monthly Expenses: B. Your Monthly Income: Gross Income: Net Income (after taxes and deductions): $ $ Spouse or Partner’s Income Gross Income: Net Income (after taxes and deductions): $ $ Other Household Income: Gross Income: Net Income (after taxes and deductions): $ $ Describe: C. Credit Cards and Other Debt: Creditor Name: Payment: Balance: Total $ $ D. Surplus/Deficit: Total Net Monthly Household Income: $ Subtract Total Monthly Expenses: $ = Monthly Surplus or Deficit $ Signature:__________________________ Date: ___________________________
PrePurchaseIntakePackage.Final_.2016.docx