Financial Planning Questionnaire

Please complete the following questions to the best of your ability. If an area or question does not apply to you, you may enter "NA" in that field.

Once completed, click submit on the bottom of the form and we will begin to build out your strategy!

First Name

Last Name

Phone

Address

Marital Status

Spouse Name

Number of children

Preferred method of contact?

Phone

What topics are you most interested in discussing?

Any other general information we should be aware of?

What is your Date of Birth

What is your Annual Household Income or Salary?

Do you contribute to a retirement plan through work? (401k, 403b, 457, etc.) What is the annual amount you contribute or percentage? Do you get a matching contribution, if so what percent?

Do you contribute to any Non-Retirement Savings or Investments on a regular basis? If so how much and what frequency?

What is the Aggregate value of any Traditional IRAs you or your spouse/partner have?

What is the aggregate value of any Roth IRAs you or your spouse/partner have?

Do you or your spouse/partner have any retirement plansor 401ks that are with prior employers? If so what is/are the approximate value?

What is the approximate value of your or your spouse/partners current employer retirement plan?

Please provide any information regarding outstanding debt including the current balance, original balance, the interest rate, the monthly minimum payment, and the term of the debt:

If you have any stock plans, please enter the details of the stock plans to the best of your knowledge, including ISOs, NQSOs, RS, and RSUs:

If you own any real estate property such as a primary home, vacation home, rental property, or investment property, please provide the details below. Otherwise please indicate if you are renting and the cost of your rent:

Please include information for any insurance policies, including life insurance, disability, long term care, etc. Please include the type of policy, insurer, the benefit amount, and the cash value:

Monthly Mortgage or Rent Expense:

Monthly HOA expense:

Monthly Maintenance expense (Lawn care, pool care, home maint):

Monthly Internet Expense:

Monthly Cell Phone Cost:

Monthly Utilities:

Monthly Child Care Expense:

Monthly Car Payment:

Monthly Car Insurance:

Monthly Pet Care Expense

Monthly Payments to Charities:

Monthly Gym or Club Dues:

Monthly Estimate for Groceries

Monthly Estimate for Dining Out:

Monthly Estimate for Entertainment:

Monthly Estimate for Shopping:

Monthly Estimate for Personal Care:

Monthly Subscriptions:

In the next 12 months, what goals do you have for yourself personally, professionally, and financially?

Between 5-10 years from now, what personal and financial goals do you have?

What are your long term (10+ years) Financial, personal, and professional goals?

In the past, what has stopped you from achieving any of these financial goals?

What do you consider to be your biggest financial challenge?

At what age would you like to retire?

Thank you for your submission! There was a problem with the form submission. Please try again.