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New Client Intake
New Client Intake
New Client Intake
New clients use this form to provide us their information.
Step
1
of
11
9%
Primary Contact Information
Name
First
Middle
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Phone
Type of Number
Home Phone
Mobile Phone
Work Phone
Use as Primary Phone Number?
Yes
No
Email
Type of Email Address
Home Email
Work Email
Use as Primary Email Address?
Yes
No
Birth Date
Month
Day
Year
Occupation
Employer
Second Contact Information
Name
First
Middle
Last
Phone
Type of Number
Home Phone
Mobile Phone
Work Phone
Use as Primary Phone Number?
Yes
No
Email
Type of Email Address
Home Email
Work Email
Use as Primary Email Address?
Yes
No
Birth Date
Month
Day
Year
Occupation
Employer
Additional Family Information
Do you have any children (even if grown and "on their own")?
Your family affects your financial outlook. Our team uses this information to give you a holistic perspective on your situation.
No children.
1 – I/we have one kid.
2 – I/we have two kids.
3 – I/we have three.
4 – I/we have four.
5 – I/we have five.
6 – I/we have six.
7 – I/we have seven.
8 – I/we have eight.
We're gonna have to discuss this, but let's start with 8.
1st Child's Name
First
Middle
Last
1st Child's Age
Please enter a number from
0
to
120
.
Is the 1st Child Married?
Yes
No
2nd Child's Name
First
Middle
Last
2nd Child's Age
Please enter a number from
0
to
120
.
Is the 2nd Child Married?
Yes
No
3rd Child's Name
First
Middle
Last
3rd Child's Age
Please enter a number from
0
to
120
.
Is the 3rd Child Married?
Yes
No
4th Child's Name
First
Middle
Last
4th Child's Age
Please enter a number from
0
to
120
.
Is the 4th Child Married?
Yes
No
5th Child's Name
First
Middle
Last
5th Child's Age
Please enter a number from
0
to
120
.
Is the 5th Child Married?
Yes
No
6th Child's Name
First
Middle
Last
6th Child's Age
Please enter a number from
0
to
120
.
Is the 6th Child Married?
Yes
No
7th Child's Name
First
Middle
Last
7th Child's Age
Please enter a number from
0
to
120
.
Is the 7th Child Married?
Yes
No
8th Child's Name
First
Middle
Last
8th Child's Age
Please enter a number from
0
to
120
.
Is the 8th Child Married?
Yes
No
Income & Account Information
First Income
Amount
1st Income Frequency
Annual
Monthly
Bi-Monthly
Twice Monthly
Weekly
1st Kind of Income
Salary/Bonus
Hourly Wages
Pension
Social Security
Other Income
Second Income
Amount
2nd Income Frequency
Annual
Monthly
Bi-Monthly
Twice Monthly
Weekly
2nd Kind of Income
Salary/Bonus
Hourly Wages
Pension
Social Security
Other Income
Third Income
Amount
3rd Income Frequency
Annual
Monthly
Bi-Monthly
Twice Monthly
Weekly
3rd Kind of Income
Salary/Bonus
Hourly Wages
Pension
Social Security
Other Income
Accounts
Which of these accounts do you have?
Checking Accounts
Savings Accounts
Money Market Account
CD
Other
Select All
Retirement & Long Term Savings
Which of these retirement and long term savings accounts do you have in place?
Traditional IRA
Simple IRA
Roth IRA
401k
HSA: Health Savings Account
Pension
529/ESA
TSP: Thrift Savings Plan
Annuity
Previous Employer Plans
Select All
Debts
Which of these debts do you currently hold?
Mortgage
Second Mortgage
Home Equity Line of Credit (HELOC)
Credit Cards
Student Loans
Car Loans
Other
Select All
Insurances
Which of the following policies do you currently have?
Life Insurance
Health Insurance
Disability Insurance: Short Term
Disability Insurance: Long Term
Long Term Care Insurance
Select All
Estate Planning
Which of these do you already have in effect?
Will
POA: Power of Attorney
Trust
Select All
Real Estate
Which of these do you own?
Primary Home
Second Home
Rental Home
Commercial Real Estate
Select All
Other
Do you have any of the following?
I own a business.
I have non-IRA investments.
I have proceeds from gambling.
Select All
Checking Account Details
Provide the balance information for each of the following accounts:
How many checking accounts do you have?
Checking #1 Balance Range
$1-999
$1,000-$4,999
$5,000-9,999
$10,000-14,999
$15,000-19,999
$20,000-29,999
$30,000-49,999
$50,000+
Checking #1 Owner
Client A
Client B
Joint
Business
Checking #2 Balance Range
$1-999
$1,000-$4,999
$5,000-9,999
$10,000-14,999
$15,000-19,999
$20,000-29,999
$30,000-49,999
$50,000+
Checking #2 Owner
Client A
Client B
Joint
Business
Checking #3 Balance Range
$1-999
$1,000-$4,999
$5,000-9,999
$10,000-14,999
$15,000-19,999
$20,000-29,999
$30,000-49,999
$50,000+
Checking #3 Owner
Client A
Client B
Joint
Business
Checking #4 Balance Range
$1-999
$1,000-$4,999
$5,000-9,999
$10,000-14,999
$15,000-19,999
$20,000-29,999
$30,000-49,999
$50,000+
Checking #4 Owner
Client A
Client B
Joint
Business
Checking #5 Balance Range
$1-999
$1,000-$4,999
$5,000-9,999
$10,000-14,999
$15,000-19,999
$20,000-29,999
$30,000-49,999
$50,000+
Checking #5 Owner
Client A
Client B
Joint
Business
Checking #6 Balance Range
$1-999
$1,000-$4,999
$5,000-9,999
$10,000-14,999
$15,000-19,999
$20,000-29,999
$30,000-49,999
$50,000+
Checking #6 Owner
Client A
Client B
Joint
Business
Checking #7 Balance Range
$1-999
$1,000-$4,999
$5,000-9,999
$10,000-14,999
$15,000-19,999
$20,000-29,999
$30,000-49,999
$50,000+
Checking #7 Owner
Client A
Client B
Joint
Business
Checking #8 Balance Range
$1-999
$1,000-$4,999
$5,000-9,999
$10,000-14,999
$15,000-19,999
$20,000-29,999
$30,000-49,999
$50,000+
Checking #8 Owner
Client A
Client B
Joint
Business
Do you have more checking accounts I'd like to discuss?
Yes
No. I put all my info in here.
How many savings accounts do you have?
Savings #1 Balance
Savings #1 Owner
Client A
Client B
Joint
Business
Savings #2 Balance
Savings #2 Owner
Client A
Client B
Joint
Business
Savings #3 Balance
Savings #3 Owner
Client A
Client B
Joint
Business
Savings #4 Balance
Savings #4 Owner
Client A
Client B
Joint
Business
I have more savings accounts that I'd like to discuss.
Yes
No. I’ve put all my info here.
Money Market Account
CD: Certificate of Deposit
Other Account Balance
Other Account Type
Information about Traditional IRA #1
IRA #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount IRA #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
Information about Traditional IRA #2
IRA #2 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount IRA #2
Frequency of Contribution
Annually
Monthly
Weekly
Other
Information about Traditional IRA #3
IRA #3 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount IRA #3
Frequency of Contribution
Annually
Monthly
Weekly
Other
Simple IRA Information
Simple IRA #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount Simple IRA #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
Roth IRA Information
Roth IRA #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount Roth IRA #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
401k Information
401k #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount 401k #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
HSA Information
HSA #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount HSA #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
Pension Information
Pension #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount Pension #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
529/ESA Information
529/ESA #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount 529/ESA #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
Thrift Savings Plan (TSP) Information
TSP #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount TSP #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
Annuity Information
Annuity #1 Account Balance
Name(s) on the Account
Upload Current Statement
Max. file size: 100 MB.
Recurring Contribution Amount Annuity #1
Frequency of Contribution
Annually
Monthly
Weekly
Other
Previous Employer Plans
Mortgage Information
Mortgage Balance
Monthly Mortgage Payment
Upload Current Mortgage Statement
Max. file size: 100 MB.
Whose name is on the mortgage?
First
Last
Is there a second name is on the mortgage?
First
Last
Second Mortgage Information
Second Mortgage Balance
Monthly Second Mortgage Payment
Upload Current Mortgage Statement
Max. file size: 100 MB.
Whose name is on the second mortgage?
First
Last
Is there another name is on the second mortgage?
First
Last
HELOC Information
HELOC Balance
Monthly HELOC Payment
Upload Current HELOC Statement
Max. file size: 100 MB.
Whose name is on the HELOC?
First
Last
Is there a second name on the HELOC?
First
Last
Credit Cards
How many credit card balances do you have?
Total of All Credit Card Balances
Credit Card #1 Balance
Card #1 Minimum Payment
Card #1 Issuing Bank
Card #1 Statement
Max. file size: 100 MB.
Credit Card #2 Balance
Card #2 Minimum Payment
Card #2 Issuing Bank
Card #2 Statement
Max. file size: 100 MB.
Credit Card #3 Balance
Card #3 Minimum Payment
Card #3 Issuing Bank
Card #3 Statement
Max. file size: 100 MB.
Credit Card #4 Balance
Card #4 Minimum Payment
Card #4 Issuing Bank
Card #4 Statement
Max. file size: 100 MB.
Student Loan Information
How many different student loans do you have?
Total of ALL Student Loan Balances
Student Loan #1 Balance
Student Loan #1 Payment
Student Loan #1 Start Date
Month
Day
Year
Student Loan #1 Company
Student Loan #1 Statement
Max. file size: 100 MB.
Student Loan #2 Balance
Student Loan #2 Payment
Student Loan #2 Start Date
Month
Day
Year
Student Loan #2 Company
Student Loan #2 Statement
Max. file size: 100 MB.
Student Loan #3 Balance
Student Loan #3 Payment
Student Loan #3 Start Date
Month
Day
Year
Student Loan #3 Company
Student Loan #3 Statement
Max. file size: 100 MB.
Car Loan Information
How many car loans do you have?
Car Loan #1 Balance
Car Loan #1 Payment
Car Loan #1 Start Date
Month
Day
Year
Car Loan #1 Issuing Bank
Car Loan #1 Statement
Max. file size: 100 MB.
Car Loan #1 APR
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