Please complete the following questionnaire to your best ability. This will help us provide the most accurate and comprehensive wealth report for you and your family.
CLIENT DETAILS

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* Name

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* Email

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* Phone number

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* Date of Birth

Date

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* Spouse's Name

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* Spouse's Date of Birth

Date

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* Income (complete as applicable) 
Please provide current Social Security Benefit Statement (if not yet taking Social Security).

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* Mortgage (complete as applicable)
Not including taxes or insurance.

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* Assets (complete as applicable)

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* Assets (complete as applicable)

Please include the following information on all your debts:

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* Debt #1

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* Debt #2

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* Debt #3

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* Debt #4

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* Debt #5

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* Additional Comments

What are the most important financial goals that you would like to accomplish? (Please prioritize with the top being your most important, and the last being the least important.)

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* If you were going to change anything in your financial situation, what would it be?

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* If we were meeting here three years from today, what has to have happened for you to feel happy with your progress?

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* We have been able to grow substantially through the power of referrals. If we fulfill your expectations, what method of
communication may we talk to you about obtaining referrals that is most comfortable for you?

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* Will there be any other advisors involved in the decision making process?

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