Personal Profile Information
ABOUT THIS DATA FORM:
Please be sure you review your information carefully. The information provided on this form will be used in our firm client database and tax reporting.
Estimated Time to Complete:
5 -15 minutes.
Primary Contact Information
The PRIMARY CONTACT'S email and mailing address will be used for all firm communications.
Primary Contact for Engagement:
First Name
Middle Name
Last Name
Email Address Policy:
The PRIMARY EMAIL is our mailing address where sensitive tax material may be sent. This is the email used for all firm communication and you will need to monitor your email periodically for important firm notifications.
Primary Email
example@example.com
Alternate Email (optional)
example@example.com
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Please Provide your Current Mailing Address
Please enter the address used for all firm mail correspondence
Current Home Address (Mailing Address)
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date of Birth
Enter your Date of Birth
Social Security Number
Enter your Social Security Number
PRIMARY Contact Number
This will be your MAIN CONTACT number
Format: (000) 000-0000.
Contact Number Type - Primary
Please Select
Cell Phone
Home Phone
Business Phone
Other
Indicate type of number
Alternate Contact Number
Enter an ALTERNATE number if necessary
Format: (000) 000-0000.
Contact Number Type - Alternate
Please Select
Cell Phone
Home Phone
Business Phone
Other
Indicate type of number
Your current tax filing status on your last filed tax return?
Single
Head of Household
Married filing Joint
Married filing Separate
Spouse Information: (if applicable)
Enter information for your spouse below as listed on your tax returns.
Spouse Name (if applicable)
First Name
Middle Name
Last Name
Spouse Email Address
example@example.com
Spouse Social Security Number
Spouse Contact Number
Please enter the best contact number
Format: (000) 000-0000.
Contact Number Type - Spouse
Please Select
Cell Phone
Home Phone
Business Phone
Other
Indicate type of number
Spouse Date of Birth
Do you have dependents you claim on your tax returns?
Yes
No
Unsure
Do any of your dependents currently work for your business?
Yes
No
Unsure
If YES, please describe jobs, duties performed.
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Dependent #1 Information: (complete as necessary)
Enter your dependent information below as listed on your tax returns.
Dependent #1 Name
Please Enter: First, Middle, Last Name
Dependent #1 Date of Birth
Please enter date of birth Month/Day/Year
Dependent #1 Social Security Number
Dependent #1 Relation
Please Select
Son
Daughter
Other
Do you have additional dependents?
Yes
No
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Dependent #2 Information:
Enter your dependent information below as listed on your tax returns.
Dependent #2 Name
Please Enter: First, Middle, Last Name
Dependent #2 Date of Birth
Please enter date of birth Month/Day/Year
Dependent #2 Social Security Number
Dependent #2 Relation
Please Select
Son
Daughter
Other
Do you have additional dependents?
Yes
No
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Dependent #3 Information:
Enter your dependent information below as listed on your tax returns.
Dependent #3 Name
Please Enter: First, Middle, Last Name
Dependent #3 Date of Birth
Please enter date of birth Month/Day/Year
Dependent #3 Social Security Number
Dependent #3 Relation
Please Select
Son
Daughter
Other
Do you have additional dependents?
Yes
No
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Dependent #4 Information:
Enter your dependent information below as listed on your tax returns.
Dependent #4 Name
Please Enter: First, Middle, Last Name
Dependent #4 Date of Birth
Please enter date of birth Month/Day/Year
Dependent #4 Social Security Number
Dependent #4 Relation
Please Select
Son
Daughter
Other
Do you have any additional dependents not listed here?
Yes
No
NOTE:
If you have addtional dependents not listed on this form, we will collect addtional information from you during our onboarding process.
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Other Current Advisor Relationships
Please let us know about any current Financial or Legal Advisors you currently work with.
FINANCIAL ADVISOR: Do you work with a Financial Advisor?
No - I do not use a financial advisor
No - But I would like a referral to one
Yes: Enter firm name &/or contact name below
BANKER: Do you work with a Banker?
No - I do not have a specific banker
No - But I would like a referral to one
Yes: Enter bank name and/or contact name below
INSURANCE AGENT: Do you work with an Insurance Agent (other than health)?
No - I do not have a insurance agent
No - But I would like a referral to one
Yes: Enter agency name and/or contact name below
LEGAL RELATIONSHIP: Do you have a current legal representation relationship?
No - I do not have a legal representative
No - But I would like a referral to one
Yes: Enter firm name &/or contact name below
ESTATE PLAN: Do you currently have a current estate plan in place?
Yes
Yes - But it should be reviewed
No
No - But I would like to have something set up
If you do have an estate plan set up, what type of plan do you have in place?
Will
Trust
Unsure
Other- Describe
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Investment Real Estate (Rentals)
Please let us know about any current Real Estate or Rental Properties you have.
Do you currently own any investment real estate or rental properties?
Yes
No
It is a goal of mine, I would like to
If you do have rentals, how are the properties Titled (name on the Deed)?
All are in our personal name
We have all properties titled in our LLC(s) name
Mixture of both - Personal and LLC
Our personal name, but would like to have them in an LLC
Any other comments about your Rentals/Investments you may deem relevant?
Miscellaneous Questions & Comments
Please let us know who referred you to our firm?
First & Last Name
Please list any other questions or comments here:
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