New Client Information

New Client Information Form
Today's Date*

MonthDayYear
Date
Legal Name*

First NameMiddle NameLast Name
Marital status
Marital Status*
Social Security Number*
Your information is secure
Birth Date*
MM/DD/YYYY
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
If you don't have one, write "None"
Home Phone
What is your preferred Phone?*
Email Address*
example@example.com
Driver's License Number*
Driver's License State*
Driver's License Expiration Date*
Country of Birth*
City of Birth*
State or Province of Birth*
U.S. Citizen?*

YESNO
If no, Country of Citizenship:
If not a US Citizen, check which applies:

Permanent U.S. ResidentNon-Permanent U.S. ResidentNon-Resident of U.S.
Bank Information
Account Type

CheckingSavings
Bank Name
Name on Account (As shown on statement)
Example: Joe and Joan Smith
Routing Number
Account Number
Trust Information
Name of Trust (if applicable)
Trust registration - (social security or tax identification no.)
Date of Trust
State / Country where organized
Name of Grantor
Employment Information
Employment Status*

EmployedNot EmployedRetiredSemi-Retired
Employer Company Name
If self employed, please put the name of your business.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation/Former Occupation*
If not retired, anticipated date of retirement
Annual Income

$0 - $24,999$25,000 - $49,999$50,000 - $99,999$100,000 - $249,999$250,000 +
Approximate Net Worth

$0 - $14,999$15,000 - $49,999$50,000 - $99,999$100,000 - $249,999$250,000 - $499,999$500,000 - $999,999$1,000,000 - $1,999,999$2,000,000 +
BENEFICIARY DESIGNATION
Primary Beneficiary
Full Legal Name of 1st Primary Beneficiary*

First NameMiddle NameLast Name
If Entity, Full Entity Name
Share Percentage of Primary Beneficiary*
Relationship to You*
SSN or Taxpayer ID Number of Primary Beneficiary*
Date of Birth of Primary Beneficiary*
Phone Number of Primary Beneficiary
Per Stirpes

Per Stirpes
Physical Address of Primary Beneficiary

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Full Legal Name of 2nd Primary Beneficiary

First NameMiddle NameLast Name
If Entity, Full Entity Name
Share Percentage of 2nd Primary Beneficiary
Relationship to You
SSN or Taxpayer ID Number of 2nd Primary Beneficiary
Required if applicable
Date of Birth of 2nd Primary Beneficiary
Phone Number of 2nd Primary Beneficiary
Per Stirpes

Per Stirpes
Physical Address of 2nd Primary Beneficiary

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Full Legal Name of 3rd Primary Beneficiary

First NameMiddle NameLast Name
If Entity, Full Entity Name
Share Percentage of 3rd Primary Beneficiary
Relationship to You
SSN or Taxpayer ID Number of 3rd Primary Beneficiary
Date of Birth of 3rd Primary Beneficiary
Phone Number of 3rd Primary Beneficiary
Per Stirpes

Per Stirpes
Physical Address of 3rd Primary Beneficiary

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contingent Beneficiaries
Full Legal Name of 1st Contingent Beneficiary

First NameMiddle NameLast Name
If Entity, Full Entity Name
Share Percentage of Contingent Beneficiary
Relationship to You
SSN or Taxpayer ID Number of Contingent Beneficiary
Date of Birth of Contingent Beneficiary
Phone Number of Contingent Beneficiary
Per Stirpes

Per Stirpes
Name of Trust: (if applicable)
Full legal name or Entity Name of 2nd Contingent Beneficiary
Share Percentage of 2nd Contingent Beneficiary
Relationship to You
SSN or Taxpayer ID Number of 2nd Contingent Beneficiary
Date of Birth of 2nd Contingent Beneficiary
Phone Number of 2nd Contingent Beneficiary
Per Stirpes

Per Stirpes
Name of Trust: (if applicable)
Full legal name or Entity Name of 3rd Contingent Beneficiary
Share Percentage of 3rd Contingent Beneficiary
Relationship to You
SSN or Taxpayer ID Number of 3rd Contingent Beneficiary
Date of Birth of 3rd Contingent Beneficiary
Phone Number of 3rd Contingent Beneficiary
Per Stirpes

Per Stirpes
Name of Trust: (if applicable)
This information is provided for informational purposes only and does not constitute a recommendation or advice for your specific situation. Investment advisory services offered by licensed investment advisors of Elevation Capital Advisory, LLC., an SEC Registered Investment Advisor. Insurance services offered by its affiliate Elevation Capital Strategies, Inc. Neither the firm nor its representatives may give tax or legal advice. Investing involves risk, including the potential loss of principal. No investment strategy can guarantee a profit or protect against loss in periods of declining values. Insurance and annuity product guarantees are backed by the financial strength and claims-paying ability of the issuing insurance company.
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New Client Information Form

Bank Information

Trust Information

Employment Information