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Your Name*

First NameLast Name
What is the best number to use to touch base with you?*

Area CodePhone Number
Street address (We do not share your info with any outside parties.)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Age*
Are you married?*

YesNoWidowedDivorced
If yes, what is your spouse's name (if applicable)?

First NameLast Name
Spouse Age (if applicable)
Do you have children?

Yes, they are grownYes, at least one is still a minorNo
Have you recently experienced any of the following (check all that apply)?*

Loss of a spouseDivorceNew childMarriageInheritanceJob changeNone of the above
Should we decide to work together, how many times a year would you like to meet face-to-face?*

Once a yearTwice a yearThree times a year
How did you hear about us?*

Online searchReferral from a clientReferral from CPA/Attorney?I read a blog articleOther
Your Goals
What is the most important thing you want to accomplish in our initial meeting together?
At what age do you want to retire (if working)?
At what age does your spouse want to retire (if working)?
What are your primary financial planning goals (check all that apply)?*

Determine when I can retireUnderstanding and managing my investmentsSaving for retirementReducing taxesCoordinating investments with tax planningAlign all my finances toward specific life goalsMaximize my employer benefitsPrepare for healthcare costs in retirementEnsure my estate plan is updatedOther
What life goals in retirement are most important to you (check all that apply)?*

Give to charity or churchTravelHelp my childrenStart a businessVolunteerLeave money to my kids/charity when I diePurchase a second homeStay fitRenovate homeOther
Real Estate
Do you own a home?*

YesNo
Do you have a mortgage?*

YesNo
Do you own any rental properties or vacant land?

YesNo
Your Investments
On a scale of 1-10, 10 being the MOST concerned, how concerned are you about losing money during a market downturn? *
We do our best work and limit our services to people with over $1 million in investments. What is the approximate combined value of all your savings, investments, and retirement accounts (excluding real estate)?*
What types of investments do you own? (Check all that apply)*

Savings or money market accountsIndex fundsIndividual stocksVariable annuitiesMutual fundsExchange trade funds (ETFs)Individual bondsCDsFixed annuitiesReal estate investment trusts (REITs)I'm not sure
What is your primary investment objective (check all that apply)?*

Preserve my moneyConservatively grow my moneyAggressively grow my moneyIncome for future (retirement)Income nowOther
Are you currently looking for a firm to manage your investments?

Yes, I prefer to delegate.Yes, if I trusted their philosophy, approach, and pricing.No, this is something I am qualified to do on my own.
Are you currently working with an investment advisor?*

Yes, but I need a second opinionYes, but they don't offer financial planningSort of, but I think they mostly sell productsNo, I'm not working with a financial advisor
Your Retirement Readiness
On a scale of 1 - 10, 10 being the MOST concerned, how concerned are you about having enough money to last in retirement? *
Do you know how much you spend on a monthly basis?*

Yes, to the pennyYes, approximatelyNo, not really
What types of retirement accounts do you have as a family (check all that apply)?*

401k planTraditional IRARoth IRA457 planProfit sharing planSimple IRA403bAnnuityOther
Have you ever worked for the federal or state government, or worked overseas?*

YesNo
Have you (or your spouse) started social security benefits?*

YesNoNo, but I need advice when I do
Do you need to decide how or when to take a pension (lump sum vs. annuity for example)?*

YesNoI don't know
Taxes and Estate Planning
Would you like help on reducing taxes on future income?*

YesNo
Do you own a business?*

YesNo
Do you prepare your own tax return?*

YesNo
Do you have a will?*

YesNo
Do you have a trust?*

YesNo
Would you like to leave a portion of your assets to your heirs, church, or charity?*

YesNoI'm not sure
Your Email - Best email to use for scheduling. We do NOT send solicitations or add this to any lists. *
example@example.com
Spouse Email (if applicable) - Best email to use for scheduling. We do NOT send solicitations or add this to any lists.
example@example.com
Thank you for completing the form. Once you click the Submit Form button below, you will be able to schedule our initial call together.
Should be Empty:

Your Goals

Real Estate

Your Investments

Your Retirement Readiness

Taxes and Estate Planning