$__________ Rent/Mortgage
$__________Car Payment
$__________Gas, Car Repairs
$__________Electricity
$__________Telephone (Cell and Regular)
$__________Cable
$__________Child Care
$__________Water
$__________Sewer
$__________Heat
$__________Insurance/House
$__________Insurance/Car
$__________Food
$__________Cigarettes
$__________Medical/Dental/Counseling Expenses
$__________Medication
$__________Alcohol
$__________Credit Card Payment
$__________Misc (haircuts, dining out, newspaper, etc.)
$__________Loans, specify: _____________________________________
_____________________________________
$__________Total Expenses
$__________Monthly Net Income