Financial Assessment

Any information you provide is 100% private and confidential. This is not a loan application, and your credit will not be checked. The details you share simply help us prepare your personalized payoff estimate before our call.

Think of it like filling out forms before a doctor’s visit — doing it ahead of time lets us spend our time together focused on solutions, not paperwork.

By submitting this form, you acknowledge that this is merely an estimate. The closer your numbers are to reality, the more accurately we can project your estimated payoff.

Basic Information First Name * Last Name * Email *

Primary Mortgage Information

What is the ORIGINAL balance on the current mortgage?

What is the OUTSTANDING current balance on the current mortgage?

What is the total mortgage payment?
Payment MUST include principal, interest, taxes, and insurance. Typically included under "escrow."

What is the interest rate?

What is the term of the loan?
10, 15, 20, 30 or 40 Year Loan? What's the estimated value of your home/property?

You can share your address to help us confirm the details and ensure more accurate data. (OPTIONAL)

Rental Properties (Only if applicable)

If you do not own any rental properties, please skip.

Estimated Value	Current Balance	Total Payment	Total Rent Received

Additional Debt Information

Other Debts such as car loans, personal loans, credit cards, student loans, or anything else listed on your credit report.

Debt Title	Monthly Payment	Balance Remaining	Interest Rate

Expenses

What are your total household monthly expenses?

Expense	Amount
Food/Groceries	$
Auto Fuel	$
Combined Utilities	$
Cable / Internet	$
Cell Phone Bill	$
Car Insurance	$
Life Insurance	$
Medical	$
School Tuition	$
Tithing	$
Entertainment	$
Subscriptions	$
Miscellaneous	$

Income

Are you Self-Employed?

Yes No

What is the YEARLY GROSS household income? (Adjusted Gross Income if Self Employed)

What is the MONTHLY NET household income? (Take home after taxes)

Savings

How much do you currently have in cash reserves?
Combined balances in Checking, Savings, and Cash on hand, etc...

Retirement

How much do you currently have in retirement accounts?
Combined balances in 401K, IRA, investment accounts, etc...

Credit Score

What is your current Credit Score (FICO)?

We are NOT performing a credit check or an inquiry on your credit report. We ask for your credit score to determine your qualification for our services. It will help us identify the best strategy for you.

Any other relevant information you want us to know during the review?

100% Privacy guaranteed. Residents of the 48 Contiguous United States only! This is NOT a credit or a loan application qualification process. This is a form to simply request more information about our services. We promise not to spam you. Currently, we are not accepting any candidates who have been bankrupt or have been in foreclosure in the last three years. We are NOT performing a credit check or an inquiry on your credit report. We ask for your credit score to determine your qualification for our services. Your information is not shared or sold to any third party.

By providing my information, I give express written consent to Accelerated Strategies to email, call and text me regarding upcoming events and reminders. I also consent to the company’s Privacy Policy.