WFP Complexity Questionnaire

Welcome to Weiser Financial Planning

To better prepare for our upcoming conversation, it is important for us to gather some additional background information about your financial world. The information you provide is strictly confidential and will help us determine a fair price to provide the highest level of service that we strive to deliver to all of our clients, while maximizing the value you receive.
First Name*
Last Name*
Phone Number*
Email*
example@example.com
Birthdate*

MonthDayYear
Date
Home Address
Street Address*
Street Address Line 2
City*
State*
Zip Code*
Employment status*

Stay-at-homeRetiredW-2 employee1099 / LLC / Sole Proprietor w/o employeesSole Proprietor with employeesC-Corp
Occupation*
Name of Employer*
What is your annual income?*
What is your marital status*

SingleMarriedDivorcedWidowedSeparated
Is this a second marriage for either spouse?

NoYes
Spouse's First Name*
Spouse's Last Name*
Spouse's Phone Number*
Spouse's Email*
Spouse's Birthdate*

MonthDayYear
Date
Spouse's Employment status*

Stay-at-homeRetiredW-21099 / LLC / Sole Proprietor w/o employeesSole Proprietor with employeesC-Corp
Spouse's Occupation*
Spouse's Employer*
What is your spouse's annual income?*
Do you have children?*

YesNo
Children's Names and Date of Birth*
How did you originally hear about Weiser Financial Planning?*
Name of Referrer*
Please answer the following questions based on your household totals (unless otherwise specified):
How many total debt (loan) obligations do you have? (Credit Cards, Student Loans, Cars, Mortgage, etc.)*

3 or less4 - 67-1011 or more
How much do you owe in Real Estate loans?*
How much do you owe in Auto loans?*
What are your total outstanding Credit Card Balances?*
What do you owe in Total Student Loans?*
How many total insurance policies do you own? (Cars, home, liability, life, disability, health, LTC, etc.)*

3 or less4 - 67-910 or more
Do you and/or your spouse have an employer sponsored retirement plan with your CURRENT employer(s)?*

YesNo
What is the estimated value of Your retirement account with your CURRENT employer?*
What is the estimated value of your Spouse's retirement account with his/her CURRENT employer?*
How many retirement accounts does your household own that are still currently held with a FORMER employer, or in IRAs?*

012345
What is the approximate combined market value of these account(s)? (not including your current employer's retirement plan)*
How many non-qualified (taxable) investment plans does your household own?*

012345+
What is the approximate combined market value of these non-qualified (taxable) accounts?*
When will you need income from your investments?*

More than 10 years6 - 10 years2 - 5 yearsLess than 2 years
How many pension plans have you qualified to receive?*

Currently receiving0123+
What are your total monthly gross pension benefit(s)?*
Do you have stock options?*

NoneOut-of-the moneyIn-the money2+ grants
What types of real estate do you own?*

None or RentPrimary Home2nd HomeRental DwellingCommercial or Other Property
Please describe (number of properties, type, etc.)
What actions have you taken in regards to your estate planning?*

NothingBasic (Wills/Power of Attorney)TrustOther
If other please explain*
When were these documents last updated?*

Less than 5 years5 - 10 years10 -15 yearsGreater than 15 years
If you add up the value of everything you own and subtract what you owe, what is your total net worth? (Assets - Liabilities)*

0 - $250,000$250,000 - $500,000$500,000 - $750,000$750,000 - $1,000,000$1,000,00 - $2,000,0002,000,000 - $3,000,000Greater than $3,000,000
What are your top financial goals and biggest challenges?
Total
Should be Empty:

Welcome to Weiser Financial Planning