Consultation Data Form

*Required Fields

Client #1 Information



Street address, P.O. box, company name, c/o

Apartment, suite , unit, building, floor, etc.


* If retired, provide prior occ and employer


Street address, P.O. box, company name, c/o


Children
Expenses
Goals

In the next five years, how much of your investments or savings do you plan on spending?


Do you have a Financial Power of Attorney?




Do you have a Living Will/Healthcare Advance Directive?




Do you have a will?



Do you expect to support someone outside of normal dependent support (handicapped child, parent, etc)?


Do you expect to receive an inheritance?

Investments

Type: PS = Passbook Savings; MM = Money Market; TB = Treasury Bills; I = IRA; R = Roth; 4T = Traditional 401K; 4R = Roth 401(k); SI = SEP-IRA; T = TSA or 403B; S = Stock; MF = Mutual Funds; RE = Real Estate Investment Trust; B = Bonds; CD = CDs; O = Other (explain)

*If your employer matches any contributions, please list amount along with your contribution

Insurance/Annuities

Type: T = Term*; U = Universal Life; V = Variable Life; VL = Variable Universal Life; W = Whole Life; VA = Variable Annuity; LT = Long-Term Car; DI = Disability; FA = Fixed Annuity

Pensions & Social Security
Real Estate Investments

Type: PR = Primary Residence; SR = Secondary Residence; RR = Rental Residential; RC = Rental Commercial; O = Other
#: F = First Mortgage; S = Second Mortgage

Liabilities/Expenses

Item/Company: Auto, Credit Cards, Student Loans, Charitable Giving, etc.

Please confirm you are not a Robot

Click here to print the completed form for your records before submitting

Once you click Submit the screen will change to indicate "Your Submission is complete"

Leave this empty:

All recommendations are based upon the information provided by you and other information disclosed in discussions. Any failure to provide complete information or to advise of material changes to retirement plans or financial situation may render such retirement planning recommendations invalid