Step 1 of 6 16% Client Name* First Last Client Birthdate* Relationship Status*SingleMarriedDivorcedCohabitationCo-Client Name First Last Co-Client Birthdate Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do You Have A Preferred Mailing Address?YesNoMailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address Co-Client Email Address Phone NumberCo-Client Phone Number Do You Have Children?*YesNoChildrenNameGenderBirthdate Click the + on the right to add more rows. Enter birthdates using the MM/DD/YYYY format. List of Investment Accounts*Account TypeOwnerValue In Account Type column write a description such as IRA, Roth IRA, 401(k), Roth 401(k), Brokerage Account, Variable Annuity etc. In the Owner Column specify who owns the account or if it is a joint account. In the Value column please list the approximate value of the account. Press the + to add another row.AssetsAssetValue Please list the approximate values of any real estate (e.g. primary home and any vacation homes), collectibles, or other assets you may have. Press the + to add another row.LiabilitiesLiabilityValue Please list the approximate values of any debt that you may have. This would include items such as mortgages, car loans, and consumer debt. Press the + to add another row. SalaryCo-Client SalaryAre you currently receiving Social Security benefits?YesNoClient Social Security BenefitsEnter the annual benefits you receive.Co-Client Social Security BenefitsEnter the annual benefits you receive.Do you have a pension?YesNoAre you currently receiving benefits from your pension?YesNoWhat is your pension income?Enter the annual income from all pensions.Other IncomeSourceIncome Enter any sources of income that do not fall into the above categories. Press the + button to add more rows. Financial Planning Priorities In order of importance please list your top three financial priorities. Press the + to add a row.What Is Your Top Investment Priority?GrowthIncomeCapital PreservationWhat do you believe is a reasonable annual return on your investments?3% to 6%6% to 9%9% to 12%Greater than 12%Please Upload Any Supporting Documents Here Drop files here or This includes any account statements, insurance documents, or any other documents you would like to review. Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.