Prospective Clients

PLEASE BRING THE INFORMATION BELOW TO YOUR FIRST MEETING:

Most recent Income Tax Return

Securities and Investment statements

Insurance information (life, disability, and long term care)

Company provided benefits 

Estimated living costs

Financial goals

NAME_______________________________________________________________________________

HOME ADDRESS_____________________________________________________________________

CITY____________________________________STATE_________________ZIP__________________

DATE OF BIRTH_____________________________SOC. SEC. #_____________________________

HOME PHONE________________________BUSINESS PHONE______________________________

FAX________________________________CELLULAR PHONE_______________________________

E-MAIL_____________________________________________________________________________

OCCUPATION_______________________________________________________________________

EMPLOYER NAME & ADDRESS_______________________________________________________

SPOUSE’S NAME___________________________________________________________________

DATE OF BIRTH_____________________________SOC. SEC. #_____________________________

OCCUPATION_______________________________________________________________________

EMPLOYER NAME & ADDRESS_______________________________________________________

BUSINESS PHONE________________________E-MAIL ___________________________________

ARE YOU A U.S. CITIZEN? __________IS YOUR SPOUSE A U.S. CITIZEN? _________________

DEPENDENTS: 

NAME                                                  DATE OF BIRTH                    SOCIAL SECURITY #

________________________                 ________________               ____________________

_________________________               ________________               ____________________

_________________________               ________________               ____________________

 

PLEASE CHECK ALL THAT APPLY:

 

DO YOU HAVE:      IRAs ____ Pension Plan ____ 401k ____ TSA ____ Roth IRA ____

529 Plan ____      Stock Portfolio ____ Life Insurance ____ Long Term Care ____

Disability Insurance ____ Other __________________________

 

WHAT ARE YOUR FINANCIAL GOALS:    House Purchase _____  Retirement  _____

College Funding _____  Charitable Giving _____  Tax Efficiency ____  Current Income _____

Home Remodeling _____ Other________

 

REFERRED BY: ______________________________________________________________________