Information Form
Today
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Month
-
Day
Year
Date
Household Name
Household ID
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Email
*
example@example.com
Email ID
Wealthbox
Phone Number
*
Please enter a valid phone number.
Phone ID
Wealthbox
Contact ID
Wealthbox
QB Contact ID
CC Contact ID
Hubly Contact ID
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address ID
Wealthbox
Will this be a joint engagement?
*
Yes
No
What is your relationship to the co-client?
*
Spouse
Partner
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Email
*
example@example.com
Email ID
Wealthbox
Phone Number
Please enter a valid phone number.
Phone ID
Wealthbox
Contact ID
Wealthbox
CC Contact ID
Hubly Contact ID
Is your address the same as above?
*
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address ID
Wealthbox
What type of planning relationship are you looking for?
*
Please Select
Ongoing financial guidance, including investment management
Ongoing investment management
Short-term guidance or one-time financial review
What is your highest financial priority right now? (The more details the better.)
*
What is your approximate Annual Gross Income?
*
Please Select
Under $75,000
$75,000 - $125,000
$125,000 - $250,000
$250,000 - $500,000
$500,000 or more
About how much do you have in savings and investments? Include brokerage accounts, bank accounts, retirement accounts, and annuities. (Retirement accounts include traditional and Roth IRA’s, workplace plans like 401(k)s, federal TSPs, deferred compensation, and profit sharing.)*
Please Select
Under $500,000
$500,000 - $750,000
$750,000 - $1,000,000
$1,000,000 - $3,000,000
$3,000,000 - $6,000,000
$6,000,000 or more
What else should we know about you?
Who referred you to us? How did you hear about Taconic Advisors?
*
Please choose a "secret word". This will be used to confirm your identity. For your security, do not share this word with anyone.
Status
Prospect Qualified
Prospect Not Qualified
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