Axia Financial, LLC

FINANCIAL WORKSHEET
Please provide us with the how much you are paying monthly for each expense. And how much income is coming into
your household each month, this may include paychecks, rents collected, alimony and child support. Also, please provide us
with approximate balances in your checking, savings and retirement accounts. MISREPRESENTATION OR FRAUD
NULLIFIES OUR MONEY BACK GUARANTEE.

MONTHLY EXPENSES INCOME

1ST MORTGAGE PAYMENT WAGES, BORROWER (NET)
2ND MORTGAGE PAYMENT
OVERTIME, BORROWER (NET)
or HELOC
TAXES WAGES, CO-BORROWER (NET)
MORTGAGE INSURANCE OVERTIME, CO-BORROWER (NET)
HOMEOWNER INSURANCE UNEMPLOYMENT
HOA FEES CHILD SUPPORT RECEIVED
UTILITIES ALIMONY RECEIVED
ELECTRICITY TENANT RENT (Primary)
GAS RENTAL INCOME (Rental )
WATER OTHER INCOME:
SEWER/GARBAGE
PHONE
CABLE/INTERNET ASSETS
CELL PHONE/PAGER CHECKING
NECESSITIES SAVINGS
GROCERIES IRA
HOUSEHOLD SUPPLIES 401K
TRANSPORTATION MUTUAL FUNDS
#1 AUTO PAYMENT OTHER:
#2 AUTO PAYMENT
AUTO INSURANCE OTHER MONTHLY LIVING EXPENSES
GASOLINE
VEHICLE MAINTENANCE
MASS TRANSIT
INSURANCE
MEDICAL/DENTAL
LIFE/DISABILITY
UNSECURED DEBTS
CREDIT CARD #1
CREDIT CARD #2
CREDIT CARD #3
STUDENT LOANS
PERSONAL LOANS
OTHER
CHILD CARE/EDUCATION
SCHOOL LUNCH
TUITION/BOOKS HOME OWNER NAME:
CHILD SUPPORT
DAY CARE
MEDICAL EXPENSES HOME OWNER SIGNATURE:
PHARMACY/PRESCRIPTIONS
HOSPITAL/CLINIC
ENTERTAINMENT DATE:
DINING OUT
MOVIES/SHOWS
HOBBIES
MISCELLANEOUS
#1
#2