Money Saver Tips.com

Consulting Profile Form

We recommend you print-out the following form (this web page), get the answers and then complete it online. Before sending/submitting it (or you can 'hit' the 'Back' button just after submittal), print a copy for your records and just in case we don't receive it. If you make a mistake and accidentally hit the 'enter' key before finishing, just 'hit' the 'Back' button to continue where you left off. Note: once you 'hit' send/submit and go to a different page/site, the information is gone, that is why we recommend printing a copy right before or right after you 'hit' 'Send Profile Form'.

Your Name:
Your Mailing Address:
Your City, State, Zip:
Your Phone Number:
Your e-mail:

Tell Us About Your Household...

Is your household income greater than $35,000?, if not we will be unable to provide any minimum savings guarantee.

Please list each person's sex & age (for example: M-27, F-26, F-4):

What is the Physical Address of where you live (street, city, state, zip)?

Do you Own or Rent?
Own Rent

If you own and have a mortgage, are you paying (as part of your monthly mortgage payment) Mortgage Life Insurance or Credit Life Insurance or something similar that pays off your mortgage if you die?
No Yes Don't Know

If you own and have a mortgage, are you paying Private Mortgage Insurance (PMI) as a part of your mortgage payment?
No Yes Don't Know

If you own and have a mortgage, What is the Market Value of your house and loan balance?

Utilities...

Put a check mark next to each of the following utilities you have and fill in the service providers name and specific monthly costs before taxes requested. There is one line under each for providing us any additional details which may be helpful.

Alarm Monitoring

Company Name:

Monthly Cost:

Additional Details:

Electric

Company Name:

Monthly Service Charge:

Price per Kwh (Kilowatt hour):

Additional Details:

Internet

Company Name:

Type: Dial-up DSL (phone line) Cable (broadband) Satellite

Monthly Cost:

Specify hours/month or Unlimited:

Do you have a phone line just for Internet Usage?: Yes No

Additional Details:

Natural Gas

Company Name:

Monthly Service Charge:

Price per unit:

Additional Details:

Telephone (local service)

Company Name:

Monthly Cost:

Caller ID Cost:

Long Distance (Pkg minutes) Cost:

How many long distance minutes included:

Wire Maintenance Plan (or similar) Cost:

Other features and cost each:

Is your Local & Long Distance bill on the same statement?: Yes No

Additional Details (more than 1 phone?):

Telephone (long distance)

Company Name:

Monthly Service Charge:

Price per minute (In State - weekends):

In State weekend minutes you average per month?:

Price per minute (Out of State - weekends):

Out of State weekend minutes you average per month?:

Price per minute (In State - days):

In State daytime minutes you average per month?:

Price per minute (Out of State - days):

Out of State daytime minutes you average per month?:

Long Distance (Pkg minutes) Cost:

Minutes included in Package:

How are minutes billed?: 6-second increments Rounded up to next minute

Is your Local & Long Distance bill on the same statement?: Yes No

Additional Details:

Telephone, Mobile (cellular)

Company Name:

Monthly Cost:

How many daytime minutes included:

Daytime minutes you average per month?:

Other features and cost each (roaming, internet):

Additional Details (more than 1 phone?):

Television Cable or Satellite

Company Name:

Please select the type of signal:

Cable Direct TV (satellite) Dish Network (satellite) Other

Monthly Cost:

Are there other packages that cost less?: No Yes

What channels that you now watch would you miss?:

How many channels do you get?:

Do you Rent any Equipment?: No Yes

What equipment do you rent and what is the charge?:

Why don't you use a "good" TV antenna?:

Additional Details:

Trash removal

Do you pay a monthly or yearly fee?: No Yes - Monthly Yes - Yearly

Monthly or Yearly Cost:

What is that fee based on?:

Who do you pay the fee to?:

How do you pay it?: In Taxes Part of Water Bill Seperate Check

Additional Details:

Insurance...

Put a check mark next to each of the following insurances you have and details requested for each. There is one line under each for providing us any additional details which may be helpful.

Auto

Cost: Weekly Monthly Quarterly Yearly

Car #1: Make, Model, Year:

Have you checked with your insurance company and received credit for all

applicable discounts for this car and its use?: No Yes

What discounts are you getting?: Air Bags Alternative Fuel Alarm

Anti-lock brakes Pleasure Use only Low Travel Miles Other

Do you have Collision coverage?: No Yes Deductible:

Do you have Comprehensive coverage?: No Yes Deductible:

What is the market value of this car (be realistic)?:

Car #2: Make, Model, Year:

Have you checked with your insurance company and received credit for all

applicable discounts for this car and its use?: No Yes

What discounts are you getting?: Air Bags Alternative Fuel Alarm

Anti-lock brakes Pleasure Use only Low Travel Miles Other

Do you have Collision coverage?: No Yes Deductible:

Do you have Comprehensive coverage?: No Yes Deductible:

What is the market value of this car (be realistic)?:

Car #3: Make, Model, Year:

Have you checked with your insurance company and received credit for all

applicable discounts for this car and its use?: No Yes

What discounts are you getting?: Air Bags Alternative Fuel Alarm

Anti-lock brakes Pleasure Use only Low Travel Miles Other

Do you have Collision coverage?: No Yes Deductible:

Do you have Comprehensive coverage?: No Yes Deductible:

What is the market value of this car (be realistic)?:

Do you carry Uninsured/Underinsured motorists coverage?: No Yes

Do you have Medical Payments (to others) coverage?: No Yes Amount:

Do people you normally carry have medical/health insurance?: No Yes

Do you have Personal Injury Protection?: No Yes Amount:

Do you (and your family) have a seperate medical/health insurance policy?: No Yes

Do you pay a premium for road service/towing for any car?: No Yes

If yes (above), what is the yearly road service premium for all cars?:

Do you have a seperate road service/towing service, such as AAA or similar?: No Yes

If yes (above), what is the yearly fee for this service?:

Please put a check mark next to discounts you may qualify for:

Driving Training Alcohol Awareness University Alumni Certain Profession or Employer

Have you asked your insurance company about each of the above discounts or others?: No Yes

Additional Details:

This Section In Further Development

Tell us what other areas you spend money on and that you would like to spend less, please provide details (especially costs and benefits).

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