| |
|
Your name
* |
|
|
Your Spouse/Significant Other's Name
|
|
|
Your Date of Birth
* |
|
|
Spouse/Significant Other DOB
|
|
|
Your Address
* |
|
|
Your Email
* |
|
|
Phone Number (in case of ?'s)
|
|
|
When do you plan to retire?
* |
|
|
Do you currently RENT or OWN?
* |
|
|
What is your monthly housing payment (rent or Mortgage)
* |
|
|
Homeowners: How much are your taxes, insurance, dues, etc, monthly?
|
|
|
Homeowners: What is your approximate home value?
|
|
|
Homeowners: How much do you owe on your home?
|
|
|
Homeowners: What is your current interest rate?
|
|
|
Homeowners: When would you like to have this home paid off?
|
|
|
Homeowners: How old will you be based on your current mortgage?
|
|
|
Do you own any investment properties or vacation homes?
|
Yes
No
|
|
How much do you currently owe in personal devbt including credit cards, car loans, student loansother personal loans (not mortgages)?
|
|
|
What is your total monthly payment on these debts?
|
|
|
What is the approximate value of your investment assets including bank accts, mutual funds, CD's, and securities?
|
|
|
What is your average rate of return on your investments and/or retirement accounts?
|
|
|
What is your combined gross household income?
|
|
|
Over the next 5 years is your income going to increase, decrease, or stay the same?
|
|
|
Do you have any major xpnses planned in the upcoming 12 months such as cars, home improvements, college tuition, new homes, or other? (please describe)
|
|
|
Would you like us to send you a copy of your credit report?
* |
Yes
No
|
|
Your social security number:
|
|
|
Spouse or Signif. Other SS#:
|
|
|
On a scale of 1-10, 10 being best, please rate the following: CPA
|
|
|
Financial Advisor:
|
|
|
Estate Plan:
|
|
|
Are you interested in purchasing real estate for investment purposes?
|
Yes
No
|
|
Do you have life insurance to protect your home?
|
Yes
No
|
|
|
