Eclectic Associates New Client Questionnaire

Welcome to Eclectic Associates

We're excited to begin working together and look forward to helping you achieve your financial goals.
The questions are designed to help us get to know your current financial situation and will take approximately 60 minutes to complete.

You can save and come back to this form by clicking the "Save" button of any page. Then follow the prompts to receive a copy of your in-progress form.

Here are a few helpful tips as you begin:
1. Please respond with your initial thoughts as there are no right or wrong answers.
2. If a question doesn't apply to you or isn't clear, feel free to skip it.
3. Share as much (or as little) information as you are comfortable. Keep in mind that the more information provided, the more detailed our initial plan can be.
4. Many of the questions request that you upload your most recent PDF statements for income, assets, insurance and tax forms. These PDF statements are typically located in the "Statements/Documents" area of their respective websites if you have online access.
5. If you do not have online access, you can either scan your full paper statements into your computer if you have a scanner or bring them to the office and we'd be glad to make copies here.

Household Information

If you have a spouse/partner who will also be working with us, we typically need only one questionnaire per household with information for both individuals.
Primary Contact
Name*

First NameLast Name
Email*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Secondary Contact (If Applicable)
Name

First NameLast Name
Email
example@example.com
Mobile Phone Number
Please enter a valid phone number.
If you prefer to maintain separate plans for your finances, please let us know in the comments below or feel free to submit separate questionnaires.
Comments

Assets & Liabilities

This section will focus on gathering information related to your current assets and liabilities. Please upload recent PDF statements where available. If a PDF statement is not available, please provide a brief description and approximate value in the "additional comments" box (e.g., BofA Checking - $5K).
Cash Accounts

Upload recent PDF statements for your accounts, including checking, savings, CDs, money markets, savings bonds, etc.
Upload Cash Account Statements

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Investment Accounts

Upload recent PDF statements for your accounts, including brokerage, IRA, Roth IRA, 401(k), 403(b), 457, stocks, bonds, etc.
Upload PDF Statements

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Real Estate Accounts

Upload recent PDF statements for your accounts, including primary residence, vacation, rental property, timeshare, etc. Please include any property tax statements, too.
Upload PDF Statements

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Custodial Accounts

Upload recent PDF statements for your accounts, including 529 college savings plans, UTMAs, UGMAs, custodial IRAs, etc.
Upload PDF Statements

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Other Assets

Upload recent PDF statements or provide details of any assets not listed above.

Examples include closely held businesses, charitable accounts, cash value life insurance policies, collectibles, automobiles, RVs, boats, etc. Please also provide approximate values.
Upload PDF Statements

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Liabilities

Upload recent PDF statements for liabilities, including mortgages, lines of credit, auto loans, credit cards, personal loans, student loans, etc.

If a PDF statement is not available, please provide a brief description, loan balance, and interest rate details.
Upload PDF Statements

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Additional Comments
Please provide any additional information that you would like to share with us regarding your assets and liabilities.

Income

This section will focus on gathering information related to your current income and expected future income.
Tax Return

Provide your most recently filed income tax return.

If you do not have a PDF file available, check the box "Ask Preparer" and provide your tax preparer's contact information below to provide us with permission to reach out directly.
Upload Tax Return

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Ask Preparer

I will provide contact information for Eclectic Associates to reach out directly to my tax preparer.
Tax Preparer Name

First NameLast Name
Tax Preparer Email
example@example.com
Tax Preparer Phone Number
Please enter a valid phone number.
Employment Income

If you are currently employed, please provide us with your prior year-end paystub and your most recent paystub.

If this doesn't apply to you, please enter "NA".
Upload File(s)

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Comments
Social Security

Please provide us with a current Social Security benefit statement, which can be obtained at www.ssa.gov/myaccount.

If you have already elected to begin Social Security benefits, you can skip this question as we will look to your tax return for this information.

If this doesn't apply to you, please enter "NA".
Upload File(s)

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Comments
Pensions

If you are eligible for any employer pension benefits, please provide us with a recent summary. Often this information is difficult to locate online.

We are looking for an estimate of what your pension benefit will be at retirement age to factor into our retirement projections for you.

Additionally, if you are aware of any "survivorship" option associated with your benefit, please include this information in the comments section (e.g., 50% joint and survivor).

If this doesn't apply to you, please enter "NA".
Upload File(s)

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Comments
Other Income

Please provide information on any other income you have or expect to receive during retirement. Examples include partnership income, rental income, royalties, etc.

If this doesn't apply to you, please enter "NA".
Upload File(s)

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Comments
Additional Information
Do you expect your income to change significantly in the near future? (Please explain)
Which of the following best describes your attitude toward your income needs?
Approximately how much are you saving annually toward retirement from all sources?
Skip this question if you are already retired.
At what age do you expect to retire and what will influence this decision?
Skip this question if you are already retired.
Please provide us with a rough estimate of your current average monthly expenses.
It’s OK to enter "I don't know."
We typically use age 95 as a default life expectancy for retirement income projections. Should we adjust this age up, down, or keep it the same based on your health and family history?

Insurance

This section will focus on gathering information related to your current insurance coverage in various areas.
If you do not have digital files available, you can provide us the information through one of two methods:
1. Check the box "Ask Agent" and provide your insurance agent's contact information so we can request a secure electronic copy from them directly via email.
2. Drop the original policies by our office and we'd be happy to scan copies of the paperwork for you.
If you do not have a policy in a particular area, simply enter "no policy."
Upload File(s)

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Life Insurance Policies
Comments
Ask Agent

I will provide contact information for Eclectic Associates to reach out directly to my insurance agent.
Agent Name

First NameLast Name
Agent Email
example@example.com
Agent Phone Number
Please enter a valid phone number.
Property, Casualty, and Umbrella Policies
Upload File(s)

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Comments
Ask Agent

I will provide contact information for Eclectic Associates to reach out directly to my insurance agent.
Agent Name

First NameLast Name
Agent Email
example@example.com
Agent Phone Number
Please enter a valid phone number.
Disability Insurance Policies
Upload File(s)

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Comments
Ask Agent

I will provide contact information for Eclectic Associates to reach out directly to my insurance agent.
Agent Name

First NameLast Name
Agent Email
example@example.com
Agent Phone Number
Please enter a valid phone number.
Long-Term Care Policies
Upload File(s)

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Comments
Ask Agent

I will provide contact information for Eclectic Associates to reach out directly to my insurance agent.
Agent Name

First NameLast Name
Agent Email
example@example.com
Agent Phone Number
Please enter a valid phone number.

Move Money Setup

As part of our account setup process, we usually find it helpful to establish an electronic ACH link between your investment accounts and a checking account of your choice to facilitate secure transfer requests in the future.
Upload a PDF statement from the bank account of your choice reflecting the account registration and full account number. Alternatively, you may also upload an image of a voided check or deposit slip from your preferred account.

You may skip this step if you are not comfortable or if you would prefer to set up later.
Upload File(s)

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Comments

Workplace Retirement Plan Login Credentials

This section is for active employer plans only.
If you are currently employed and actively participating in a workplace retirement plan—such as a 401(k), 403(b), or 457—we can help you evaluate the investment options available within your plan and integrate these accounts into your overall financial plan.

In most cases, it’s most beneficial to keep these accounts with your current provider while you remain employed to take advantage of possible matching and/or profit sharing contributions from your employer.

If you're comfortable sharing login credentials, we can securely access your account to research available investment choices and attempt to establish a data feed into our portfolio management system. Please note that we may need your assistance with two-factor authentication (2FA) during the initial setup.

To receive help, please provide the list of accounts in the space below. Then we will contact you based on your preferences to collect your login credentials.
Accounts List
How should an Eclectic Associates team member contact you to collect your login credentials?

Call me so I can share my information over the phone.Send me an email so I can submit my information online.I will visit the Eclectic Associates office in person.
Should be Empty:

Welcome to Eclectic Associates

Household Information

Primary Contact

Secondary Contact (If Applicable)

Assets & Liabilities

Cash Accounts

Investment Accounts

Real Estate Accounts

Custodial Accounts

Other Assets

Liabilities

Income

Tax Return

Employment Income

Social Security

Pensions

Other Income

Additional Information

Investment Planning

Risk Tolerance

Additional Information

Estate Planning

Insurance

Life Insurance Policies

Property, Casualty, and Umbrella Policies

Disability Insurance Policies

Long-Term Care Policies

Move Money Setup

Workplace Retirement Plan Login Credentials