Account OpeningThis form will address the suitability information required for all account openings. Name * First Name Last Name Address * Legal Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Email * DOB * MM DD YYYY SSN * Do you wish to add a Trusted Contact? * Yes No If yes, please provide the below information: Annual Income * $0 - $50,000 $50,000 - $100,000 $100,000 - $250,000 $250,000 - $500,000 $500,000 + Estimated net worth * Assets minus liabilities EXCLUDING primary residence $0 - $50,000 $50,000 - $100,000 $100,000 - $250,000 $250,000 - $500,000 $500,000 - $1 million $1 million - $5 million $5 million + Federal tax bracket * If unknown, please estimate 0 - 15% 16 - 25% 26 - 30% 31 - 35% Over 35% Annual expenses * If unknown, please estimate $0 - $50,000 $50,000 - $100,000 $100,000 - $250,000 $250,000 - $500,000 $500,000 + Investment purpose * Education Retirement Short term goals Other Account funding source * Where is the money to open the new account coming from? Savings Sale of assets Asset appreciation Inheritance Legal/insurance settlement Other Investment objective * Income with limited growth Income with moderate growth Growth and income Primarily growth Growth Time horizon * What is the time horizon for these investments? Near term (less than 1 year) Very short term ( 1 - 3 years) Short (3 - 5 years) Intermediate (6 - 10 years) Long (10 + years) General investment knowledge * Limited Good Extensive Thank you! Your submission will be routed to our office staff to take the next action.
