| Car payment |
$_____________________ |
| Other installment loan payments
with ten or more monthly payments remaining (furniture, appliance, etc.) |
$_____________________ |
| Average monthly credit card
payments |
$_____________________ |
| Student loan payments |
$_____________________ |
| Medical/health care payment |
$_____________________ |
| Alimony/child support payment |
$_____________________ |
| Other monthly payments |
$_____________________ |
| Total Monthly Debt |
$___________________ |