JVC Financial Organization Client Form

JVC Financial Organization Financial Needs Analysis

Welcome to JVC Financial Family Organization! I’m so glad you’re here — this is the first step toward taking control of your financial future. This form is designed to help me get a full picture of your current credit and money management needs so I can build your customized packet. Please take your time and answer each section honestly. 💳 Important: All services require a non-refundable fee. A 50% deposit is required to begin your welcome packet. The remaining balance is due before your consultation appointment can be scheduled. No exceptions. Let’s work together to build something that lasts. Your journey starts here!
Full Name *
Phone Number
Please enter a valid phone number.
Address

Street Address Line 1

Street Address Line 2

CityState

Zip CodeCountry
Your Birth Date

DayMonthYear
Email
example@example.com
Spouse's Birth Date

MonthDayYear
Spouse's Name

First NameLast Name
Spouse's Cell
Spouse's Email
example@example.com
Please select a service package below: (All packages are non-refundable and require 50% up front)*

Sprinkle ($140) – A budget-focused starter plan to help you track spending and reset your finances. Includes a welcome letter, budgeting tools, and a personalized financial overview.Sparkle –( $175)- Includes everything in the Sprinkle package plus: A full credit snapshot, custom paydown plan, 30/60-day action steps, and credit-building homework.Shine Bright –( $275)- Includes everything in the Sprinkle + Sparkle packages plus: student loan support, 12-month payoff projection, personalized client trackers, financial wins journal, and a follow-up strategy plan and more.
Add-On Services (Select any that apply)

student Loan Breakdown – $25Business Credit Starter – $35Monthly Accountability Check-In (15 min) – $30Customized Savings Challenge – $25Emergency Fund Plan – $25Credit Card Tracker Setup – $25Debt Payoff Strategy – $30Add 3 or more and receive 10% off your total add-on price.
Child 1

First NameLast Name
Child's Date of Birth

MonthDayYear
Child 2

First NameLast Name
Child's Date of Birth

MonthDayYear
Child 3

First NameLast Name
Child's Date of Birth

MonthDayYear
Child 4

First NameLast Name
Child's Date of Birth

MonthDayYear
Any additional children list names and DOBs
Profession
Do you intend to retire there?
How often do you get paid?*

WeeklyEvery Two WeeksBi-MonthlyMonthlyOther
Your take home (net) pay*
Spouse's Occupation
How often does your spouse get paid?

WeeklyEvery Two WeeksMonthlyNo IncomeOther
Your spouse's take home (net) pay
Total All Additional Income
Do you receive any additional monthly income?

NoneSocial SecurityDisabilityAlimonyChild SupportRetirement or PensionRental Property (provide details during appt)Other
What is your biggest financial headache?
understanding how money works
Housing (renting)

OwnRentLiving rent free with family or friends
When are you planning to buy a house?
Monthly rent or mortgage
If multiple mortgages, provide detail at appt
Interest Rate
%
Balance of Mortgage
Amount of Car Payment 1
Approximate Total Owed
Amount of Car Payment 2
Approximate Total Owed
Amount of Credit Card or Loan
Approximate Total Owed
Amount of Credit Card or Loan
Approximate Total Owed
Amount Credit Card of Loan
Approximate Total Owed
Additional Credit Card Debts Data (name/balance/rate)
Do you have a loan out on your current 401k/403b/457/TSP?
If applicable list payment per check
Remaining Balance of loan on current retirement account
If applicable - list remaining balance
Last Filed Income Tax Refund

$0 to $1000$1000 to $3000Greater than $3000I owed and paid less than $1000I owed and paid more than $1000I still owe the IRS
Approximate Utilities (gas, water, trash, electric)
Approximate Tech (internet, cell, cable)
Approximate Monthly Grocery Exp
Approximate Monthly Eating Out Exp
Approximate Car Ins Exp
Approximate Fuel Exp
Approximate Health Ins Exp
Approximate Hobies
Approximate Child Care
Approximate Child Support
Approximate Alimony
Approximate Personal Care
Haircuts, Beauty, Massage, Therapies, etc
What type of retirement accounts do you have? (Please have any statements at appt)

Current 401k/403b/457/TSPOld 401k/403b/457/TSPIRARoth
What type of retirement accounts does your spouse have? (Please have any statements at appt)

Current 401k/403b/457/TSPOld 401k/403b/457/TSPIRARoth
Approximate Retirement Value (current)
Approximate Retirement Value (old)
Spouse Retirement Value (current)
Spouse Retirement Value (old)
Approx Liquid Cash (savings / stock)
College Savings (529 or other savings)
What type of life insurance do you have? (Have policy or any paperwork with you at appt)

NoneGroup (through employer)Term (temporary - covers specific amount of years)Permanent (has cash value)
How much do you feel you have left over after all the bills are paid?
Scale of 1-10, how serious are you about improving your family's financial situation?

1

2

3

4

5

6

7

8

9

10

1 is Not Serious, 10 is Very Serious
Acknowledgment of Payment Terms (required):*

I understand that all payments, including deposits and add-ons, are non-refundable. A 50% deposit is required to begin my packet, and the remaining balance must be paid before my consultation can be scheduled.
Date

MonthDayYear
Date
Signature*

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JVC Financial Organization Financial Needs Analysis