Financial Goals, Planning, and Vision Assessment
This form helps you evaluate your current financial situation, set goals, and create a strategic plan for your financial future.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your current financial planning status.
*
Working with a financial advisor
Work benefits ONLY
Bank ONLY
Open to work with a professional and learn more.
How would you rate your current financial knowledge?
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1
2
3
4
5
(1 Star meaning not knowledgeable 5 star meaning very knowledgeable)
Marital Status
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Single
Married
Divorced
Widowed
Total Number Dependents
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0
1
2
3+
Total Household Income
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Under $40,000
$40,000 - $70,000
$70,000 - $100,000
$100,000+
PLEASE describe your main Financial Goals (Click those that apply ONLY)
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Homeownership
Debt Freedom
College Savings
Increase my Income
Start a side business
Generational Wealth
Do you have a Will or Estate Plans
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Yes
No
Do you have a Trust
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Yes
No
Would like to SAVE money on your auto insurance?
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Yes
No
Do you currently have Life Insurance outside of your job
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Yes
No
Do you currently have a 401K or a retirement plan outside of your job
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Yes
No
Do you currently have an old 401K or retirement with a previous employer?
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Yes
No
Which areas are you most interested in improving?
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Life Insurance Protection
Saving & Investing
Debt Elimination Strategy
Will & Trust Set Up
Retirement Planning
Increasing my income
IF Something Happen TODAY….Would your family: (Click ONLY those that apply)
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Cover funeral expenses without going in debt?
Pay off the remaining bills & mortgage?
Maintain their current lifestyle and housing?
Be protected from legal confusion?
Receive an inheritance smoothly?
I would like to receive:
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FREE 10-Minute Financial Audit
Will & Trust Legacy Session
FULL Financial Needs Analysis
Mortgage / Home Buyer Education
Wealth & Income Strategy Session
On a scale of 1 to 10, how confident are you in achieving your financial goals?
*
Minimum (1)
1
2
3
4
5
6
7
8
9
Maximum (10)
10
1 is Minimum (1), 10 is Maximum (10)
Submit Assessment
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