Introductory Questionnaire

The first step of the journey is discovery. We need to get to know you a bit better. By filling this out, we can understand your goals, your dreams, your time horizon, and what you’ve already done to get you where you are now. Then we can get to work and come up with some observations, suggestions, and options for you to consider.

Are you ready?

Name *

First Name

Last Name

Email *

Cell Number *

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Client DOB *

YYYY

Spouse Name

First Name

Last Name

Spouse DOB

YYYY

Services of Interest *

Financial planning

Investment management

Budgeting/Cash flow

Insurance review

Retirement account advice

Socially responsible investing

Occupation *

Where do you work and for how long

Monthly income *

Take home pay each month

Monthly expenses *

Give us your best guess. We can send a detailed budget form, if preferred.

Monthly savings *

Amount towards bank, IRA, 401k, or other.

Bank account/emergency fund balance *

Retirement account #1 balance *

IRA, 401Km 457, Roth

Retirement account #2 balance

IRA, 401Km 457, Roth

Non-retirement investments *

Brokerage accounts, CD's, etc. (Don't include your bank balance or emergency fund here.)

Desired retirement age *

Amount of life insurance *

Death benefit amount. If none, enter $0

Need more life insurance? *

Financial goals

Which of these are on your radar?

Retirement

College

Saving for a house

Paying off debt

Leaving a legacy

Donating to a charity

Other

Dreams *

In your own words, describe what is most important for you. What would you love to accomplish? How does your life look in your dreams? As Teddy Roosevelt said, "Dare mighty things!"

Anything else we should know? *

Thoughts, concerns, bonuses, benefits, long-term care, pensions, timeframes, experiences, expectations?

How did you hear about us? *

Thank you!

Questions?

This communication is strictly intended for individuals residing in the states of Arkansas, Arizona, California, Colorado, Connecticut, Washington, D.C., Florida, Illinois, Indiana, Michigan, New Jersey, New York, Ohio, Pennsylvania, Puerto Rico, South Carolina, Texas, Virginia, Wisconsin, and Wyoming. No offers may be made or accepted from any resident outside these states due to various state regulations and registration requirements regarding investment products and services. Securities and advisory services offered through Commonwealth Financial Network®, Member FINRA/SIPC, a Registered Investment Adviser. Fixed insurance products and services are separate from and not offered through Commonwealth. For more information, please refer to FORM CRS, found here.