CLIENT INFORMATION FORM

CLIENT INFORMATION FORM

Please complete this form so that our team can prepare your paperwork. The information in this form will be encrypted and submitted to Cornerstone securely.
Primary Individual's Information
Legal Name - First & Last Name (Primary Individual)
Street Address
City
State
Zip
Telephone (Primary Individual)
Date of Birth (Primary Individual)

MonthDayYear
Date
Email Address (Primary Individual)
example@example.com
Social Security Number (Primary Individual)
Place of Employment (Primary Individual)
Position (Primary Individual)
Tenure with Company (Primary Individual)
Secondary Individual's Information

(If applicable)
Legal Name - First & Last Name (Secondary Individual)
Telephone (Secondary Individual)
Date of Birth (Secondary Individual)

MonthDayYear
Date
Email Address (Secondary Individual)
example@example.com
Social Security Number (Secondary Individual)
Place of Employment (Secondary Individual)
Position (Secondary Individual)
Tenure with Company (Secondary Individual)
Children's Information

(If applicable for 529 accounts or beneficiary information.) If not needed, please scroll down to Financial Information section.
Legal Name (Child 1)
Date of Birth (Child 1)

MonthDayYear
Date
Social Security Number (Child 1)
Beneficiary Percentage % (Child 1)
Percentage
Legal Name (Child 2)
Date of Birth (Child 2)

MonthDayYear
Date
Social Security Number (Child 2)
Beneficiary Percentage % (Child 2)
Percentage
Legal Name (Child 3)
Date of Birth (Child 3)

MonthDayYear
Date
Social Security Number (Child 3)
Beneficiary Percentage % (Child 3)
Percentage
Legal Name (Child 4)
Date of Birth (Child 4)

MonthDayYear
Date
Social Security Number (Child 4)
Beneficiary Percentage % (Child 4)
Percentage
Legal Name (Child 5)
Date of Birth (Child 5)

MonthDayYear
Date
Social Security Number (Child 5)
Beneficiary Percentage % (Child 5)
Percentage
Financial Information
Current Total Household Income
Value of Business Interest
How Business Value was Determined
Are any of your assets held in a Trust?

YesNo
Projected Annual Social Security Benefit (Primary Individual, if over age 60)
Projected Annual Social Security Benefit (Secondary Individual, if over age 60)
*** Please upload a copy of your Driver License or photo ID below.

We need a copy of the ID for both the Primary and Secondary Individuals (if applicable).
Browse and upload an image of your Driver License or photo ID here.

Cancelof
Or, take a picture of your Driver License or photo ID here.
Should be Empty:

CLIENT INFORMATION FORM

Primary Individual's Information

Secondary Individual's Information

Children's Information

Financial Information