Personal Information

Let's start with the basics about you and your spouse/partner

Primary Client

Legal First Name *

Legal Last Name *

Preferred Name What should we call you?

Date of Birth *

Social Security Number *

Driver's License #

Cell Phone *

Work Phone

Email *

Current Address *

Marital Status *

Employment Information

Your Employer

Your Occupation

Annual Salary

Years with Current Employer

Family Information

Tell us about your family members and dependents

Children

Other Dependents

Are you financially responsible for anyone else? (Parents, siblings, etc.)

Health Considerations

Are there any health issues or special needs we should be aware of for planning purposes?

Assets - Real Estate

Let's capture information about your real estate holdings

Assets - Investment Accounts

Tell us about your investment and retirement accounts

Taxable Investment Accounts

Retirement Accounts (401k, IRA, etc.)

Other Assets

Cash/Savings/Checking Total

Business Interests Value

Liabilities

What do you owe?

Mortgages

Other Debts

Total Credit Card Debt

Total Student Loans

Auto Loans Total

Other Loans/Debts

Insurance Coverage

Help us understand your current protection

Life Insurance

Disability Insurance

Do you have disability insurance?

Monthly Benefit Amount

Long-Term Care Insurance

Do you have long-term care insurance?

Daily Benefit Amount

Income & Expenses

Understanding your cash flow

Annual Income

Your Salary/Wages

Spouse's Salary/Wages

Bonuses/Commissions

Investment Income

Rental Income

Other Income

Monthly Expenses

You can provide either detailed expenses or just an estimate:

Total Monthly Living Expenses (estimate) Include housing, food, transportation, insurance, entertainment, etc.

Savings

Monthly amount saved/invested (outside retirement plans)

Emergency fund balance

Estate Planning

Protecting your legacy

Do you have a will?

Do you have a living trust?

Power of Attorney?

Who are your primary beneficiaries?

Are there any specific estate planning concerns or goals?

Your Goals & Objectives

What matters most to you?

When do you want to retire?

What are your top 3 financial goals?

What keeps you up at night regarding your finances?

Investment Objective

Risk Tolerance

Time Horizon

Review Your Information

Please review your information before submitting

Summary

I confirm that the information provided is accurate to the best of my knowledge

I have read and agree to the Privacy Policy and Terms of Service

Additional Comments or Questions

Comprehensive Financial Discovery