Current Financial Snapshot (PW)

Current Financial Snapshot

Thank you for your interest in potentially working together! Please take a few minutes to fill out the following questionnaire. This form is end-to-end encrypted.

Please note that filling out this form DOES NOT commit you to anything, it only starts the process towards a complimentary analsyis (if looking for an ongoing relationship) or a one-time financial plan.

Once you've submitted this form, you will be redirected to a page to schedule an introductory call.

Basic Information
First Name*
Last Name*
Email*
example@example.com
Phone Number*
Preferred form of communication:*

EmailTextPhone call
Age*
Occupation*
Company*
Self-employed?
Do you have a valid US Social Security Number?*
Because of my jurisdiction and regulation, I can only serve those with a valid US Social Security Number (e.g. US citizens, green card holders, and visa holders).
Annual Income*
Just input your income information. If you have a spouse/partner there will be a place below to input their income.
Do you prepare your own taxes?*

YesNo
Do you have a spouse/partner?*

YesNo
Spouse/Partner Information
Name*

First NameLast Name
First Name*
Last Name*
Email*
example@example.com
Phone Number*
Age*
Occupation*
Company*
Self-employed?
Do you have a valid US Social Security Number?*
Because of my jurisdiction and regulation, I can only serve those with a valid US Social Security Number (e.g. US citizens, green card holders, and visa holders).
Annual Income*
Household Cash & Investments
Types of Investment (select all that apply)*

Checking / savingsRSUsStock options (ISOs / NQSOs)Taxable brokerage (including ESPP)401k/403bTraditional / Rollover IRARoth IRAHealth Savings Account529 college savingsReal estate (excluding your primary home)Other
Total Value*
Household Debts
Type of Debt (select all that apply)

Credit cardCar loanStudent loanNoneOther
Total Balance of Household Debts (not including a mortgage)
What's On Your Mind?
(select all that apply)*

I need help planning for stock compensationI need help with my investmentsI need help getting my cash flow in orderI need help with tax planning / optimizing my taxesI want to know how to steward my resources betterI want to know what it will take to get to financial independenceOther
What kind of help/engagement are you looking for?*

OngoingOne-time / limitedI'm not sure
Comments / Other Information
Upload any documents that may assist in our initial discussion (this is completely optional)

Cancelof
How did you hear about me or my firm (Prospurpose Wealth)?*

ReferralGoogle/Online SearchSocial Media (Twitter, LinkedIn, Instagram, Facebook)XY Planning NetworkKingdom Advisors / KA affiliatesOther
If we're a good fit to partner together, how ready are you to get started?*

1

2

3

4

5

6

7

8

9

10

1 is Exploring my options, 10 is 100% Ready
Type a question

I acknowledge that I've reviewed Prospurpose Wealth's fee scheduled located at:
Please add me to "The Millennial Memo" newsletter
Should be Empty:

Basic Information

Spouse/Partner Information

Household Cash & Investments

Household Debts

What's On Your Mind?