Thank you for signing up for your custom budget!

Please fill out all fields below and leave anything that doesn't pertain to you blank.
 
Also, make sure to make a one-time payment of $39.99 by clicking here to pay via Paypal - https://www.paypal.me/middleclassdad/39.99
 
No Paypal account is necessary.

Or just plug my home email address into your Paypal account and pay that way - jtlc512@gmail.com
 
I will start on your budget upon receiving your form and payment.  All budgets will be ready and emailed to you within 72 business hours along with a customized plan to help you succeed.

Household Info

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Rent or Mortgage

Utility Bills

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Credit Cards & Loans

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Savings & Investments

Fill in the minimum amount you pay for each month. If one doesn't apply, just leave blank. If you have additional bills use the comment box below.
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Insurance

Fill in the minimum amount you pay for each month. If one doesn't apply, just leave blank. If you have additional bills use the comment box below.
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By checking this box I acknowledge that I am sharing personal information electronically and I understand the risks of doing so. I also acknowledge that the information will be deleted upon receiving the customized budget plan. I also understand and hold Jeff Campbell dba Middle Class Dad harmless from any breech of information on the part of Formsite & Paypal and the internet providers used in our transaction. Lastly I understand that I am not asking for or receiving professional financial advice. I am seeking assistance with my personal bill payment and understand that Jeff Campbell dba Middle Class Dad is offering his assistance based on his personal experience and research. No financial goals are stated or implied and I understand if I need professional financial advice I will seek a qualified professional in my area. *
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