Burgesser Wealth Management Client Intake Questionnaire

Burgesser Wealth Management Client Intake Questionnaire

Complete this detailed onboarding form with approximate financial details and upload documents via the secure advisor portal.
Household & Contact Information
Client full name

First NameMiddle NameLast Name
Spouse/partner full name

First NameMiddle NameLast Name
Preferred name(s)
Client email address
example@example.com
Client phone number
Please enter a valid phone number.Format: (000) 000-0000.
Client mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Client date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Marital status
State of residence
Client employment status
Client retirement status
Dependents (if applicable)
Planning Priorities & Goals
Financial planning priorities

Other
Desired retirement age - client
Desired retirement age - spouse/partner
Lifestyle goals in retirement
Major planned purchases

Other
Education funding goals

Other
Legacy goals and intended beneficiaries
Comfort with market risk
Income Sources
Income source(s) included

Other recurring income
Amount frequency
Salary / wages amount
Salary / wages payer or employer
Salary / wages belongs to
Bonuses amount
Bonuses payer or source
Bonuses belongs to
Self-employment income amount
Self-employment business or source name
Expenses & Spending
Monthly household expenses
Annual irregular expenses
Desired retirement spending target
Expected inflation rate (%)
Known large future expenses
Show retirement-specific spending questions
Assets & Investments
Asset / Investment Entry
Include any employer-sponsored retirement plans, personal retirement accounts, education savings accounts, brokerage accounts, health savings accounts, annuities, and business ownership interests.
Which types of assets do you hold?

Other
Which of the following account types should be entered below?

Other
Institution Name
Account Type
Owner
Approximate Balance
Contribution Amount
Contribution Frequency
Cost Basis
Investment Allocation / Holdings Summary
Does this asset have taxable gains tracking?
Business Interest Description
Ownership Percentage
Real Estate & Property
Property Details
Liabilities
Liabilities
Liability Type
Outstanding Balance
Interest Rate (%)
Monthly Payment
Remaining Term (Months)
Lender Name
Secured or Unsecured
Insurance Coverage
Insurance Policies
Insurance Type
Policy Owner
Insured Person
Policy Type
Coverage Amount
Annual Premium
Beneficiary Details
Policy Notes
Policy Features / Riders

Other
Tax Profile
Filing Status
Approximate Marginal Tax Bracket
Estimated Federal Taxable Income
Estimated State Taxable Income
Tax Carryforwards

Other
Planned Roth Conversions

Other
Charitable Giving Methods

Other
RMD or QCD Activity / Expectations

Other
Additional Tax Notes
Retirement Income Planning
Do you expect to receive a pension in retirement?
Pension details
When do you expect to start your pension?
Expected Social Security claiming age for Primary client
Expected Social Security claiming age for Spouse/Partner
Estimated monthly Social Security benefit for Primary client
Timing preferences and survivor/spousal considerations
Estate Planning
Will status
Trust status
Powers of attorney in place
Beneficiary designations review status
Gifting intentions

Other
Inheritance expectations
Notes on guardianship arrangements
Notes on estate coordination
Risk, Liquidity & Restrictions
Risk Tolerance
Liquidity Needs
Cash Reserve Preference
Investment Restrictions or Exclusions

Other
Concentrated Positions

Other
Employer Stock or Stock Options
Special Instructions for Account Management
Document Checklist, Follow-Up & Secure Upload
Which documents can you provide?

Other supporting documents
Document checklist confirmation
Advisor follow-up questions or items to clarify
Preferred follow-up topics

Other
Secure upload instructions
Take a photo of any paper documents you want to upload
Upload supporting documents

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Burgesser Wealth Management Client Intake Questionnaire

Household & Contact Information

Planning Priorities & Goals

Income Sources

Expenses & Spending

Assets & Investments

Real Estate & Property

Liabilities

Insurance Coverage

Tax Profile

Retirement Income Planning

Estate Planning

Risk, Liquidity & Restrictions

Document Checklist, Follow-Up & Secure Upload