Client Data Sheet
Client Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Driver's License Number
*
Issuing State
*
Expiration Date
*
-
Month
-
Day
Year
Date
Retired?
*
Yes
No
Occupation (if not Retired)
*
Employer's Name (If changed within last 2 years)
*
Employer's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Bank Name
*
Suitability
Financial Situation & Tax Status
Estimated Annual Income
*
Estimated Net Worth
*
Estimated Liquid Net Worth
*
Annual Recurring Expenses
*
Special Expenses (if any)
*
Assets Held Away
*
Federal Tax Bracket
*
15% and below
15.1% - 27.5%
Over 28%
Investment Purpose(s) - Select All That Apply
*
Save for Education
Generate Income
Preserve Wealth
Retirement Purposes
Accumulate Wealth
Market Speculation
Save for Short-Term Goals
Other
Investment Objective
*
Current Income
Balanced
Growth & Income
Growth
Maximum Growth
Investment Time Horizon
*
Short (less than 5 years)
Intermediate (5-10 years)
Long (over 5 years)
Investment Knowledge
*
None
Limited
Good
Excellent
Investment Experience (Indicate # of Years)
*
Number of Years
Current Balance
Mutual Funds
Stocks
Bonds
Limited Partnerships
Variable Annuities
Options
Alternative Investments
Employer Plans
Managed Accounts
Other
Liquidity Needs
*
Please Select
Very Important
Somewhat Important
Not Important
Does Not Matter
Beneficiary Name (if changed in last 2 years)
First Name
Last Name
Beneficiary Name (if changed in last 2 years)
First Name
Last Name
Beneficiary Name (if changed in last 2 years)
First Name
Last Name
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