Consultation Data Form

*Required Fields

Client #1 Information

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

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

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

Suite , unit, building, floor, etc.


2. What are your average monthly expenses?


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 receive an inheritance?


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


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


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

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