Date
Current Age Person 1
First Name Person 1
Last Name Person 1
Email Person 1
Phone Person 1
Profession Person 1
Employer Person 1
Address
City
State
Postal Code
First Name Person 2
Last Name Person 2
Current Age Person 2
Phone Person 2
Email Person 2
Profession Person 2
Employer Person 2
Whole Life ($):
Term ($):
INCOME
Salary/Wage Income (Before Taxes):
Social Security/Pension Income (Before Taxes):
Social Security/Pension Income (Before Taxes):
ASSETS
Annuities:
Savings, Money Market, CDs:
College Savings (529/Coverdell Plans):
Taxable Investments (Stocks, Bonds, Options, REITS, Mutual Funds):
Employer Pensions Plans (Defined Benefit, MPPP, Profit Sharing):
Investment Real Estate (Office Buildings, Rental Properties):
IRAs, Roth IRAs, SEPs:
401K, 403B, 457, TSP, Simple:
Personal Property:
Closely Held Business Interests (Partnerships, Corporations, Limited Partnerships):
Home:
Second, Vacation Homes:
Second, Vacation Homes:
Total Assets:
LIABILITIES
Home Mortgage (First, Seconds, HELOCs):
Consumer Loans (Credit Cards, Student Loans, Car Loans, Etc.):
Investment Real Estate or Business Loans:
Total Liabilities:
NET WORTH
Total Net Worth (Assets less Liabilities):
Please prioritize the financial assistance you are seeking (1-Top Priiority, 2-Second...6-lowest):
Asset & Income Protection:
Investment Strategy Planning
Retirement Planning
Financial Coaching/Counseling
Cash Flow Management (i.e. Spending Plan, Budgeting)
Estate Planning
Tell us about your most important financial concerns and what you would like to accomplish through this engagement:
Tell us about your most important non-financial concerns right now?
Describe how you envision your lifestyle five years from now. (What are you doing or becoming, where, how, etc.)
Describe previous experiences working with financial advisors or financial therapists. What was good/unsatisfactory?
Tell us how you make important financial decisions?
Tell us about future financial changes that you wish to plan for. (i.e. family obligations / inheritances...)
During our review 3 years from now, what will you need to have happened for you to be satisfied with your progress?
Tell us about past litigation involvements. What happened?
Describe your ideal relationship with a financial planner or financial therapist.
Is there anything else we need to talk about?
Where did you hear about us?
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