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9550 S Eastern Avenue Las Vegas, NV 89123
+1 (702) 329-0282
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Client Intake Form
To give our financial planning advisors the best opportunity to help you with tax saving strategies please fill out our client intake form below, prior to your scheduled meeting.
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Primary Contact
*
First
Last
Phone Number
*
Phone Type
HOME
WORK
CELL
Best Time to Contact You:
8 AM - 12 PM
1 PM -5 PM
6 PM - 10 PM
Email
*
Email
Confirm Email
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
------ Personal / Family Information -------
Date of Birth
*
Age:
*
Married
*
YES
NO
Spouses Name (If Married)
First
Last
Spouses Date of Birth (If Married)
Spouses Age:
*
Have Children
*
YES
NO
# Of Children
Take Daily Prescriptions:
*
YES
NO
Smoker:
*
YES
NO
Alcohol
*
YES
NO
Do You Own Life Insurance:
*
YES
NO
Do You Own Primary Residence:
*
YES
NO
------ Financial Data -------
Occupation / Industry:
*
Total Annual Household Income: ($)
Investment Portfolio Size:
*
< $100K
$100K - $250K
$250K +
Current Types of Investment(s) (Check all that apply)
Stocks, Bonds, Mutual Funds
Real Estate
Qualified Accounts
Business Owner
*Other (Leave note)
Investment Type Notes:
Owns Qualified Account:
*
YES
NO
If Yes What Type of Account(s)
IRA
401K
SEP
PENSION
*Other (Leave note)
Qualified Account Notes:
Any Account With Employers
*
YES
NO
Total In Employer Accounts: ($)
Own Investment Properties:
*
YES
NO
You Occupation
How Do You Hold Titles?
TRUST
COMPANY
CLIENTS NAME
*Other (Leave note)
Investment Property Notes:
Cash Available at End of Month: ($)
*
Total Net Worths: ($)
*
Please Tell Us
*
Please share with us any specific investment goals, areas of interest for investing, and any other questions or pertinent information that will allow us to help you with your investement options and strategies.
Terms and Conditions
*
YES, I WISH TO TAKE ADVANTAGE OF THE FREE CONSULTATION AND ANALYSIS
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