Name *

First Name

Last Name

Phone Number

(###)

###

####

Your Date of Birth

MM

DD

YYYY

Spouse Date of Birth

MM

DD

YYYY

Do you have a Revocable Living Trust?

Yes

No

Not Sure

Do you own or rent your personal residence?

Own

Rent

Neither

Do you currently own any rental properties?

Yes

No

Are you interested in owning rental properties?

Yes

No

Not Sure

What type of life insurance do you have?

Term

Whole/Universal

Other

None

Do you own any digital assets?

Cryptocurrency

NFTs

Other

None

Do you own any foreign assets (including bank accounts)?

Yes

No

Do you have health insurance?

Yes

No

Do you have an HSA or FSA?

HSA

FSA

None

Which of the following retirement accounts do you have?

401k

Traditional IRA

Roth IRA

SEP IRA

Other

Our advice is dependent upon the timeliness, accuracy and completeness of the information and representations that we receive from you. Providing us with inaccurate or incomplete information or representations may result in inaccurate findings or inappropriate recommendations, and critical recommendations may not be identified. We shall have no liability for any loss suffered by you resulting from inaccurate or incomplete information, or your failure to provide relevant information. *

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