Getting To Know You
Please take a few minutes to tell us more about yourself prior to scheduling a meeting.
Personal Details
Please answer as many fields as possible. If you'd like us to review your investments, these copies can be submitted at the bottom of the form.
Full Name
*
First Name
Last Name
Cell Phone
*
Email
*
example@example.com
Birthday
*
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Year
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tell us about your job:
*
Spouse or Joint Contact Details
Full Name
First Name
Last Name
Cell Phone
Email
example@example.com
Birthday
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
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14
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17
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19
20
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22
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25
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28
29
30
31
Day
Please select a year
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2024
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2020
2019
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2015
2014
2013
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2010
2009
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2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
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1984
1983
1982
1981
1980
1979
1978
1977
1976
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1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Tell us about your job:
More About Your Situation
What prompted you to contact us today?
*
How did you hear about us?
*
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Referral
Online / Social Media
Magazine / Ad
Other
Please Specify
*
What items would you like to discuss in order to best utilize our time together (please check all that apply)?
Do you have a deadline for making any of these financial decisions?
*
Tell us more about your family (marital status, name of spouse, children, other dependents, important medical information, etc.):
Are you currently working with a financial advisor?
*
Yes
No
What other professionals do you work with (CPA, attorney, agent, etc.)?
Are you happy with your previous investment results?
Yes
No
Not Applicable
Do you have a drink preference?
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Coffee (regular, decalf, flavored)
Hot Tea
Soft Drink (please specify)
Water
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Optional: If you have investment statements or other documents we need to preview, please upload them securely here:
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