Pre-Appointment Form

The following items would be helpful to have at the time of our visit:
1. All brokerage firm statements
2. All life insurance & annuity policies
3. All IRA & retirement statements
4. 2 Years of Tax Returns
5. Social Security Statement (SSA.gov)
CONTACT INFORMATION
Name
First Last
Nickname
Date of Birth
MM slash DD slash YYYY
Working At/Retired From:
Current/Former Occupation:
Retired?
Spouse Name
First Last
Spouse Nickname
Spouse Date of Birth
MM slash DD slash YYYY
Spouse Working At/Retired From:
Spouse Current/Former Occupation:
Spouse Retired?
Home Phone:
Cell Phone:
Email Address:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Were you referred to us?
If so, by whom?

FAMILY
Number of Children
Number of Grandchildren
Do any of your children or grandchildren have special needs?
Are any of your children or grandchildren listed as joint owners on any of your accounts/assets?
Family Notes:

CASH FLOW
Please list monthly income from each source.
Pension
You
Your Spouse
(Survivor Options)
You
Your Spouse
Social Security
You
Your Spouse
Wages
You
Your Spouse
Other Income
You
Source(s)
Total
Other Income
Spouse
Source(s)
Total
Are these amounts net or gross?
How much are your monthly expenses?
Here are some common expenses:
Mortgage, Food, Gas, Car Loan, Insurance, Utilities, Gifts/Donations, Medical, Taxes, Social Security, etc
Total

Additional Information
If you are not already retired, when do you want to retire?
How did you acquire your wealth?
How involved would you like to be with your investments?
What is most important about your money to you?
Are you more concerned about growing your assets or protecting what you already have?

Objectives
Which of the following describes your risk tolerance when it comes to retirement assets?
What are your Financial Objectives? (Check all that apply)
- Income Now
- Tax-Deferred Growth
- Guarantees Provided
- Pass Assets to Beneficiaries
- Growth Potential
- Other
By submitting your contact information, you consent to be contacted regarding retirement income strategies that utilize investments and insurance products.
Phone
This field is for validation purposes and should be left unchanged.

The following items would be helpful to have at the time of our visit: