Client Intake & Appointment Form

This form goes straight to me — no spam, no multiple calls.
Your answers help me come prepared so our conversation is focused and useful.
At the end, you’ll choose a time, and I’ll personally reach out then.
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Xavien Jones
Licensed Life Insurance and Annuity Broker License #3377995

🧠 Did You Know?

Without proper planning, a child receiving more than $2,000 in assets — including life insurance payouts or inheritance — can lose access to essential benefits like SSI and Medicaid.That’s why many families create a Special Needs Trust or use annuities designed to provide lifetime income without disqualifying their child from government support.These tools can help ensure a child is cared for — even when parents are no longer able to provide direct support.

Term Life Insurance

Affordable coverage for a set period; ideal for income replacement, mortgage protection, or raising children.

Whole Life Insurance

Lifetime coverage with guaranteed premiums and cash value growth.

Universal Life Insurance

Flexible coverage with adjustable premiums and potential cash value growth.

Annuities (Retirement)

Guaranteed, safe income for retirement to protect against inflation.

Annuities (Special Needs Planning)

Designed to ensure a steady, reliable income for loved ones with special needs.

Mortgage Protection Insurance

Tailored life insurance designed to pay off or cover your mortgage if you pass away, ensuring your family can remain in the home without financial strain.