To Qualify For Your Appointment You Must Complete This Form

1

Full Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

4

Do you own and operate your practice as a small business?* This field is required.

YESNO

5

What is your estimated annual pre-tax income (not including your significant others)* This field is required.

6

What is your estimated annual pre-tax income (including your significant others if applicable)

7

What is your estimated combined total value of all your assets?* This field is required.

8

Do you own any real estate (not including your primary residence)* This field is required.

YESNO

9

Please share more details about your real estate investments (What kind of real estate do you own? What is the estimated total combined value? Do you have a mortgage on it?)

10

Do you have $500,000 or more in cash equivalents? (Liquid assets)* This field is required.

YESNO

12

Do you have retirement accounts? (401k, IRA, Etc)* This field is required.

YESNO

13

What is the estimated total value of your retirement accounts?

14

Do you have any debt?* This field is required.

YESNO

15

What type of debt do you have and what is the estimated total debt amount?

16

Are your finances fully optimized or do you believe there is room to increase your opportunity? If so where?* This field is required.

Taxes

Investments / Wealth Building

Cash Flow

Estate Planning / Asset Protection / Insurance

Scaling or Selling a business

Credit Card Points / Hotel Memberships / Airline Memberships

I am fully optimized and Crushing It!

17

Do you have a minimum of $200k to invest into the "program"?* This field is required.

YESNO