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Address:
Jacksonville
,
FL
32208
Phone:
904-469-7771
E-mail:
j.proffit@adviserfocus.com
New Member Data Input
PLEASE FILL ALL INFORMATION
1
Names, DOB, Net Incomes, Occupations
Your Full Name
Your Spouse's Full Name
Your Net Income
Your Spouse's Net Income
Your Occupation
Your Spouse's Occupation
Your DOB
Your Spouse's DOB
2
Children's Names and DOB
Child 1 Full Name
Child 1 DOB
Child 2 Full Name
Child 2 DOB
Child 3 Full Name
Child 3 DOB
Child 4 Full Name
Child 4 DOB
Child 5 Full Name
Child 5 DOB
3
Home
Mortgage Total
Monthly Mortgage Payment
APR%
4
Car
Total Car Loan
Car Loan Monthly Payment
APR%
5
Student Loan
Student Loan Total
Student Loan Monthly Payment
Company
6
Bank
Total Savings
Total Children's Savings
Total Credit Card Debt
Credit Card Monthly Payment
APR%
Credit Card Limit
7
Insurance
Life Insurance Company
Year
Annual Cost
Cash Value Amount
Disability Insurance Company
Covered Percent of Wages
8
Investments
401K Contribution
Employer Match Amount
IRA Total
IRA Annual Contribution
9
Accounting and Legal
Accountant Name
Accountant Email
Do You Have a Will or Trust?
None
Will
Trust