PRELIMINARY QUESTIONS Name * First Name Last Name Phone * (###) ### #### Email * What is your primary address? * Address 1 Address 2 City State/Province Zip/Postal Code Country What is your birthdate? * MM DD YYYY Current Marital Status * Single Married Divorced Widowed/Widower Other If applicable, what is your spouse's name and birthdate? How many children do you have? * None 1 2 3 4 5 6 7 8 9 10 or more If applicable, list your children's ages. Have you worked with a Financial Planner before? * Yes No Why do you want to work with a Financial Planner? At what age would you like to "retire" or be "financially independent"? Briefly describe what you would like "retirement" or "financial independence" to look like for you (ex. lots of travel, start a business, no work at all, work part-time, give back, volunteer). What is your current occupation? What is your approximate gross annual household income? What is an estimate of your current monthly expenses? Do not include any saving or investing that you are doing. How much are currently saving/investing per month (in dollars)? How much do you currently have in savings? What types of investments do you currently have (check all that apply). * Employer retirement plan (401k 403b 401a Profit Sharing SEP IRA Simple IRA etc.) Employer Pension Employer stock options or ESPP IRA Roth IRA Non-retirement investment account Annuity (Fixed Indexed or Variable) Real Estate (not including your primary residence) Crypto Currency Precious Metals Own a business Other Do you own your home? * Yes No What is a rough estimate of your net worth? (all assets minus all liabilities) How did you hear about us? Thank you!
