Suitability Form

Suitability Form
Thanks for taking 5 minutes to complete this form. Periodically, we are required by regulatory authorities to confirm certain information about you and your investment profile.
Name*

First NameLast Name
Email (your response to this form will be emailed back to you for your file)
example@example.com
Today's Date*

MonthDayYear
Date
Mobile Phone Number

Area CodePhone Number
Birth Date*

MonthDayYear
Annual Income*
Occupation*
Please indicate JOB TITLE or indicate RETIRED or NOT EMPLOYED
Anticipated Retirement Year/Year Retired
Estimated Net Worth (Assets - Liabilities)*

Tax Bracket*

Rows	10% (up to $19,000)	12% (up to $77,000)	22% (up to $165,000)	24% (up to $315,000)	32% (up to $400,000)	35% (up to $600,000)
Federal Tax Bracket (Joint Income)

YesNo
ImmediatelyIn the next 1 - 3 yearsIn the next 3 - 5 yearsIn the next 5 - 10 yearsBeyond 10 years
YesNo
Less than $10,000$10,000 - $20,000$20,000 - $40,000More than $40,000
No home ownership, I rentUnder $50,000$50,000 - $100,000$100,000 - $250,000$250,000 +
None12 +

Investment Experience*

Investment Objective: Please describe one objective below that would best describe your investment objectives. *
Risk Tolerance (Select One)*
0 - 2 years2 - 5 years5 - 10 years10+ years
Investor Attitude
Who cares? One calendar quarter means nothingI wouldn't worry about losses in that time frameIf I suffered a loss of greater than 10% I'd get concernedI'd have a hard time stomaching any losses
Signature Disclosure *
By signing below, I represent and warrant that the information provided on this Suitability Form is my best estimate of my financial profile. I understand this information will be used to make investment suggestions, determine actual investments and establish the risk level on my account(s). It should be consistent with my choices on the Investment Advisory Agreement. I represent that I will notify Strategic Retirement Advisors in writing immediately if there is any material change in the information I have provided and I acknowledge that I have received, read, understand, and agree to be bound by and to abide by all of the terms and conditions set forth in this Suitability Form. Strategic Retirement Advisors may use third parties to perform administrative tasks on its behalf such as preparation of account applications and other account forms. I acknowledge that I am solely responsible for reviewing my account documentation for accuracy and completeness.
Signature*

Clear
Should be Empty: