"As Is" Financial Snapshot
I'm excited that you’re interested in working together! Filling out this quick form does not commit you to anything, but it does start the process. Once submitted, you will be given a link to schedule an introductory meeting.
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Basic Information
Name
First Name
Last Name
Legal First Name
*
Preferred First Name
Last Name
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Preferred form of communication:
*
Email
Text
Phone call
Age
*
Under 30
30-39
40-49
50-59
60-69
Over 70
Occupation
*
Company
*
Self-employed?
Annual Income
*
Under $100K
$100K-$150K
$150K-$200K
$200K-$250K
$250K-$300K
$300K-$350K
$350K-$400K
$400K-$450K
$450K-$500K
Over $500K
Do you prepare your own taxes?
*
Yes
No
Do you have a spouse/partner?
*
Yes
No
Spouse/Partner Information
Name
*
First Name
Last Name
Legal First Name
*
Preferred First Name
Last Name
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Age
*
Under 30
30-39
40-49
50-59
60-69
Over 70
Occupation
*
Company
*
Self-employed?
Annual Income
*
Under $100K
$100K-$150K
$150K-$200K
$200K-$250K
$250K-$300K
$300K-$350K
$350K-$400K
$400K-$450K
$450K-$500K
Over $500K
Household Cash & Investments
Types of Investment
*
Checking / savings
RSUs
Stock options (ISOs / NQSOs)
Taxable brokerage
401k/403b
Traditional / Rollover IRA
Roth IRA
Health Savings Account
529 college savings
Real estate (excluding your primary home)
Other
Total Value
*
Under $500K
$500K-$1M
$1M-$2M
$2M-$4M
$4M-$6M
$6M-$10M
Over $10M
Household Debts
Type of Debt
Credit card
Car loan
Student loan
Other
Total Balance
Under $10K
$10K-$25K
$25K-$50K
$50K-$100K
$100-$200K
Over $200K
What's On Your Mind?
I need help planning for stock compensation
I need help getting my cash flow in order
I need help with tax planning / being prepared for my tax bill
I want to know what my path to financial independence will look like
I need help with my investments
Am I saving enough for college?
Other
Comments
How did you hear about Java Wealth?
*
Referral
YouTube
Google Search
Social Media (LinkedIn, Twitter, Instagram, Facebook)
XY Planning Network
Other
Who is this awesome person who referred you?
*
If we are a good fit, how ready are you to get started?
*
1
2
3
4
5
6
7
8
9
10
Just Exploring
100% Ready
1 is Just Exploring, 10 is 100% Ready
Upload any documents that may assist in our initial discussion (this is completely optional)
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Acknowledgements
Quarterly Fee
Estimated "all-inclusive" price for financial planning + investing services
${quarterlyFee}/qtr
Value
I/We have reviewed the firm's pricing & it's not a deal-breaker
Equal Partners
*
We acknowledge that both of us have an equal voice in our financial decisions & will both attend our intro conversation
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