EFG CLIENT DATA FORM

Dependent Information
DEPENDENT INFORMATION
Please enter SS # as xxx-xx-xxxx and Birthdate as mm/dd/yyyy

Please Note : Be sure to enter this infomation below to prevent tax preparation delays.

Financial Services
FINANCIAL SERVICES
Are you are interested in receiving a complimentary consultation of your retirement/investments accounts for suitability/diversification?
Please answer the following 1 through 5:
1=not important 5=extremely important
How important is saving for retirement?*
Having the necessary financial plan/funds to pay off debt.*
Improving your credit score.*
Ensuring the protecting of your family and assets.*
Increasing your net worth and living "your" life.*
Having cash liquidity to increase wealth accumulation.*
Are you currently contributing to a retirement account?
Are you currently covered under any life insurance policy(including annuities)
If yes, what type.
Are you interested in boosting your credit score or have your credit repaired *

Bank Information
BANK INFORMATION
Would you like your refund deposited into your bank account?
Bank *
Are you currently covered under any life insurance policy(including annuities)
Routing Number *
Account Number*
Referred by
How did you hear about us ?
Did you make an appointment? If no , please make an appointment by visting our website www.efg365.com*
Please upload files if possible ( Tax related documents w2, 1099 etc

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TAXPAYER'S SIGNATURE
I certify that I would like my taxes professionally prepared according to the information provided above.
Taxpayer Signature & Date *

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Spouse's Signature & Date

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