Obsidian Capital Management Register Form

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Thank you for looking into booking a consult with Obsidian Wealth Management wanting to learn more about what is and how our Legacy Wealth Plan™ and Legacy Wealth Trust™ can provide substantial benefits to you, your business and your family.

In order to know who we are working with, we require a signed NCNDA along with you to fill this form out which lets us know you are serious about learning more and are booking a consult with us.

It also helps keep our conversation 100% confidential. This confirms you that we keep your information private and protected. Privacy and compliance are of the upmost importance to us.

We appreciate your donation and look forward to assisting you.

Here is to your success!

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Lead Status

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Please enter todays date* This field is required.

Date

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First Name* This field is required.

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Last Name* This field is required.

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Name of Business* This field is required.

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Industry Type* This field is required.Please tell us what industry you work in such as Home Improvement/Construction, Canabis, Education, Farming, Dental, Medical, Real Estate, Resturant, Logistics ect...

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Title of Business* This field is required.This would be like Owner, Managing Partner, CEO, President ect...

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Business Website* This field is required.Please put your business website here. We want to make sure you are a legit business.

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Business Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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How many employees do you have?* This field is required.

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Last Years Annual Revenues* This field is required.Please let us know what your income was from last year. This gives us an idea of how we may be able to help.

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Services Your Interested In* This field is required.Please select all services that you are interested in utilizing with Obsidian Wealth Management Trust.

Regular Tax Planning

Legacy Wealth Plan™ which includes: Legacy Wealth Trust™, Tax Planning & Family Estate & Wealth Planning (everything we offer)

Increase Revenues with Streamlined Customer Financing & Digital Payments

Legacy Wealth Leveraged Life Insurance (Legacy Leveraged Retirement Account)

401k Rollover

Self Directed IRA LLC

Legacy Wealth Leveraged Annuities

Obsidian Capital Managment (Crypto AI Trading Partnership)

Bookeeping-Accounting Services (available only if not referred by a CPA or Accounting Partner)

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Your Best Email* This field is required.

example@example.com

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

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Mobile Phone* This field is required.Enter your country code, then your area code and rest of phone number example if in USA it would look like 1-800-555-6666

country Code-example USA = 1

Area code and Phone Number

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Please Verify Your Mobile Phone Number * This field is required.Enter your cell phone number again and an authorization code will be sent to your mobile phone shortly where you will enter it in the confirm code section that will pop up.

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Company or Business ownership percentage* This field is required.

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Please upload your drivers license for compliance purposes.* This field is required.

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