Client(s): Number of Clients?
1
2
Client 1
Name
*
First Name
Last Name
Gender
Male
Female
N/A
Birthday
*
/
Month
/
Day
Year
Date
Referred By
Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer
Marital Status
Single
Married
Divorced
Widowed
Name of spouse?
Do you have dependents?
Yes
No
How many?
Dependents' Names - Ages
Hobbies?
At Means Wealth Management, we take pride in pairing our clients with the most compatible advisory team. Please let us know if there are any hobbies or personal interests you enjoy that may help us better match you with an individual or team.
Retired?
*
Yes
No
Target Retirement Age
Already Taking Social Security?
Yes
No
Social Security Estimate at Full Retirement Age
Estimated Net Worth
*
$100,000 - $500,000
$500k - $1M
$1M - $5M
$5M +
Estimated Annual Income
*
Estimated Tax Bracket
*
10%
15%
25%
28%
33%
35%
39.6%
Unsure
Do/Did you own your own business?
*
Yes
No
Name/Type of Business?
Client 2
Name
*
First Name
Last Name
Gender
Male
Female
N/A
Birthday
*
/
Month
/
Day
Year
Date
Referred By
Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
Same address as above?
Yes
No
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer
Marital Status
Single
Married
Divorced
Widowed
Name of spouse?
Do you have dependents?
Yes
No
How many?
Dependents' Names - Ages
Hobbies?
At Means Wealth Management, we take pride in pairing our clients with the most compatible advisory team. Please let us know if there are any hobbies or personal interests you enjoy that may help us better match you with an individual or team.
Retired?
*
Yes
No
Target Retirement Age
Already Taking Social Security?
Yes
No
Social Security Estimate at Full Retirement Age
Estimated Net Worth
*
$100,000 - $500,000
$500k - $1M
$1M - $5M
$5M +
Estimated Annual Income
*
Estimated Tax Bracket
*
10%
15%
25%
28%
33%
35%
39.6%
Unsure
Do/Did you own your own business?
*
Yes
No
Name/Type of Business?
Liquid Assets
(IRA’s, 401k’s, Joint Accounts, Trusts, etc.)
Hard Assets
(Real Estate, Business Ownership, Gold, Collectible Cars, etc.)
Pensions and Annuities
Other important financial information we should know
(Lottery Winnings, Inheritance, Insurance Settlements, etc.)
Insurance
Liabilities
(Mortgage, Auto, Home Equity Line of Credit, Credit Card, etc.)
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*
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