Estate Planning Intake
Answer the following questions:
Name
*
First Name
Last Name
Email
*
example@gmail.com
Phone Number
*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
What is your occupation?
Preferred contact method
*
Please explain how you found us
*
Date of birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Marital status
*
Please Select
Single
Married
Divorced
Widow
Name of Spouse
Date of Birth
-
Month
-
Day
Year
Date
What is your spouse's occupation?
Do you have children?
*
Yes
No
Please list the name of child/children and ages.
Do you or your spouse have children from a previous relationship?
*
Yes
No
Please list the name of child/children, ages and mother and father.
Are there any special needs or special concerns?
Do you currently have any estate planning documents?
Yes
No
Please list documents.
Do you own real estate?
Yes
No
Please list the address(es)?
Do you own any LLC or other business interests?
Yes
No
Please describe.
Do you own a vehicle or vehicles?
Yes
No
Year, make and model
Do you have checking and/or savings accounts?
Yes
No
Bank and approximate value.
Do you have life insurance?
Yes
No
Company and approximate value.
Do you have a retirement account?
Yes
No
Company and approximate value.
Do you have any other investments?
Yes
No
Company and approximate value.
Do you have any specific goals for this planning?
Is there any other information that you would like to tell us?
Submit
Should be Empty: