Financial Services Request Form

The JEWELS organization has hand-picked qualified professionals who can assist you in areas of Legal and Financial Services.  Each of these licensed individuals who have committed to work with the JEWELS program understands the need for Financial Security for women and has committed to provide services at either a deeply discounted rate, or no charge at all, depending on the services needed.

If you are looking for someone you can trust to guide you through Estate and Retirement planning, you may call the JEWELS 800 number, or complete the request form below.


If you are already a JEWELS member, please complete the following section for verification purposes and then skip to Section 2

JEWELS Members:

Name : 

Phone Number:     OR Email: 



Financial Services Request Form

Section 1:

Name:       Date of Birth:

Spouse:     Date of Birth:

Address:   City:     State:     Zip:

Home Phone:   Cell Phone:   Email:


Section 2:

Please select your marital status (please select one):

Single           Married         Divorced           Widowed  


Please Select Your Areas of Interest:

Estate Planning            Social Security Issues        Long Term Care Issues  

Annuity Analysis           Lawsuit Avoidance         Best Investments for Retirees  

Lifetime Income           Legal Documents Update      Charitable Giving Strategies  

401k / 403b Rollover to IRA        Taxation       Comprehensive Protection Plan  


I would like information sent to my:     Email Address        Mailing Address  

Additional Comments:

 



We are glad you have visited our web site and want to make your experience as easy and personal as possible.   We appreciate your sharing this information with us and it will be kept secure. 

Thank you!

DISCLAIMER: The JEWELS organization does not give Legal, Tax, or Financial Advice