Personal Financial Snapshot

Please provide the following information:

Personal Information
Your Name *
Your Name
Spouse's Name
Spouse's Name
(if applicable)
Please provide your full mailing address
Phone
Phone
Income
$
Do you have an irregular income?
Do you use a monthly budget?
Savings
$
Are you currently investing for your retirement?
$
$
Do you contribute to non-retirement investments?
$
$
Do you rent or own?
Are you current on your payments?
$
Consumer Debt
Do you have any vehicle loans?
Are you current on your vehicle payments?
$
List any Total Balances Due
$
$
$
$
$
Focus of Sessions
What primary issue should we focus on during your coaching session?
Terms & Conditions *
 

Privacy Terms and Conditions:

By agreeing to these terms, you are confirming that this agreement is entered into by and between yourself and Provisioned Ministries for the purpose of preventing the unauthorized disclosure of Confidential Information.

1. "Confidential Information" includes all information or material that has or could have any sort of value in your personal affairs.

2. Provisioned Ministries’ obligations under this agreement do not extend to information that is publicly known at the time of disclosure or subsequently becomes publicly known through no fault of Provisioned Ministries or information that is disclosed by Provisioned Ministries with your prior written approval.

3. Provisioned Ministries will hold and maintain Confidential Information in strictest confidence for your benefit. Provisioned Ministries will carefully restrict access to Confidential Information to employees as is required for properly assisting you with financial expertise and care. Provisioned Ministries shall not publish, copy, or otherwise disclose to others, or permit the use by others for any reason whatsoever of any Confidential Information without your prior written approval. Provisioned Ministries shall return to you any and all records, notes, and other written, printed, or tangible materials in their possession pertaining to Confidential Information immediately if you request it in writing.

4. The nondisclosure provisions of this agreement shall remain in effect indefinitely unless you send Provisioned Ministries written notice releasing them from the agreement.

5. Nothing contained in this agreement shall be deemed to constitute either party a partner, joint venturer, or employee of the other party for any purpose.

6. If a court finds any provision of this agreement invalid or unenforceable, the remainder of this agreement shall be interpreted so as best to effect the intent of the parties.

7. This agreement expresses the complete understanding between you and Provisioned Ministries with respect to the subject matter and may not be amended.

8. The failure to exercise any right provided in this Agreement shall not be a waiver of prior or subsequent rights. This agreement shall be binding on the representatives of Provisioned Ministries and any such assignee of yours.