Laputka Intake Sheet
First Name
Last Name
Phone
*
Housing
Housing Status
Owner
Rental
Other
Monthly Rent or Mortgage Amount
Market value of home owned
$
Total owed in mortgage debt
$
Behind on Rent or Mortgage
Yes
No
Number of Months Behind
Less than 3 Months
More Than Three Months
Number of Properties Owned (if more than one)
Vehicles
Number of Vehicles
Vehicle Ownership
Financed
Paid Off
Vehicle Notes
Vehicle 1
Year
Make
Model
Monthly Payment
Amount Owed
Vehicle 2
Year
Make
Model
Monthly Payment
Amount Owed
Vehicle 3
Year
Make
Model
Monthly Payment
Amount Owed
Vehicle 4
Year
Make
Model
Monthly Payment
Amount Owed
Debt Types
Credit Card
Medical
Taxes
Student Loans
Personal Loans
Vehicle Loan
Other
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Total Estimated Debt
0-10k
10-30k
30-90k
90k Plus
No elements found. Consider changing the search query.
List is empty.
Lawsuit or Foreclosure
Pending Lawsuit or Foreclosure
Yes
No
Foreclosure Sale Date
Lawsuit Hearing or Court Date
Marriage and Income
Marital Status
Married
Single
Divorced
Number of People in Household
Number of Dependents
Employment Type
Business Owner
1099
W2
Estimated Monthly Income
$
Retirement Accounts
Yes
No
Retirement Account Totals
0-20k
20-50k
50k Plus
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List is empty.
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