How did you hear about us and / or find us??
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Name
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First Name
Last Name
Your Age
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Are you Married?
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Yes
No
Widowed
Divorced
Spouse Name (If Applicable)
First Name
Last Name
Spouse Age
Your Address
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We do not share your information with any marketing company or outside companies
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Do you have children?
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Yes, at least 1 minor
Yes, they are grown
No
If Yes, do you or your spouse have children from previous marriages?
Yes
No
What are you primary financial planning objectives?
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check all that apply
Determining when retirement is realistic
Coordinating investment with tax planning
Saving for college for children or grandchildren
Understanding and managing my investments
Aligning all the financial pieces toward a goal
Saving for retirement
Reducing taxes
Other
Other: Please share any additional information related to your goals or areas where you are hoping we can assist.
Do you or your spouse have any of the following types of benefits plans?
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check all that apply
Deferred comp plan (401k, 403B, etc)
ESPP (Employee Stock Purchase Plan)
ESOP (Employee Stock Ownership Plan)
Stock Options
Pension Plan
SERP (Supplemental Executive Retirement Plan)
Do you have personal debt other than a mortgage?
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Yes
No
An auto loan(s)
College debt too
Do you own a home?
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Yes
No
Do you have a mortgage?
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Yes
No
Do you own any rental properties?
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Yes
No
When you add up values for all savings, investments and retirement accounts you have roughly:
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$0 - $250,000
$250,001 - $500,000
$500,001 - $1,000,000
$1,000,001 - $1,500,000
$1,500,001 - $2,000,000
$2,000,001 - $5,000,000
$5,000,001 - $10,000,000
$10,000,000 +
What is your primary investment objective?
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Safety, preserving capital
Income for retirement
Growth for future use
Are you currently working with an investment advisor / planner?
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Yes, but need a second opinion
Yes, but they don't offer planning
Sort of, but I think they mostly sell products
No
Are looking for a firm to manage your investments?
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Yes, I prefer to delegate
Maybe, if i trust their approach and pricing
No, this is not something I would delegate.
Do you need help determing what types of insurance you should own?
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Yes
No
Please check off which types of retirement accounts you (and / or your spouse) have.
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check all that apply
IRA
SEP
Roth IRA
SIMPLE IRA
401K
403B
457 Plan
Annuity
Profit sharing
Other (we will ask in meeting)
Please explain your "Other" situation
Have you ever worked for the federal or state government, or worked overseas?
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Yes
No
Not sure
Do you need to decide how or when to take a pension (ex: lump sum vs annuity)
Yes
No
I don't know
Do you have a will?
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Yes
No
I have a good will. I just haven't put on paper yet.
Do you have a trust?
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Yes
No
I don't know
Is leaving assets to an heir or charity an important goal?
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Yes
No
If I have enough
Have you recently experience the following?
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check all that apply
Divorce
New child
Marriage
Inheritance
Job change
Loss of spouse
Empty nest
First kid goes to college
Other
Other explain your "Other" situation
Are you self-employed
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Yes
No
Do you prepare your own income tax return?
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Yes
No
Schedule A Conversation or A Meeting:
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Please share the best Day / Times during business hours for meetings, any restrictions on meeting times, and anything else you thing we need to know at this point. PUT N/A OF NOTHING ELSE TO ADD.
How Did You Learn About Us?
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Click all that apply
Referral**
Facebook
Google
Yelp
Dave Ramsey SmartVestor
Website
Billboard Ad
Other
Your Best Contact #
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Please provide the best number to use to touch base regarding scheduling options?
(###)
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Spouse Best Contact # (If Applicable)
(###)
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