Client Intake Record for [[contact.firstname]] [[contact.lastname]]

1. First Name: [[contact.firstname]]

2. Last Name: [[contact.lastname]]

3. Age: [[contact.client_age]]

4. Email: [[contact.email]]

5. Spouse First Name: [[contact.spouse_first_name]]

6. Spouse Last Name: [[contact.spouse_last_name]]

7. Spouse Age: [[contact.spouse_age]]

8. The primary goal of the portfolio is to provide: [[contact.what_are_the_goals_and_objectives_specifically_for_the_money_you_have_invested_today_]]

9. The secondary goal of the portfolio is to provide: [[contact.the_secondary_goal_of_the_portfolio_is_to_provide_]]

10. Do you have a financial plan? [[contact.do_you_have_a_financial_plan_]]

10a. If Yes, Have there been any new changes in Salary? Large Purchases? Anything we need to know? Any change in your future goals? [[contact.have_there_been_any_new_changes_in_salary__large_purchases__anything_we_need_to_know__any_change_in]]

10b. If No, Are you interested in going through the planning process? [[contact.are_you_interested_in_going_through_the_planning_process_]]

11. Are you retired? [[contact.are_you_retired_]]

11a. If Yes, Date you retired: [[contact.retirement_date]]

11b. If No, Age you would like to retire: [[contact.ideal_retirement_age]]

12. Is your spouse retired? [[contact.is_your_spouse_retired_]]

12a. If Yes, Spouse retirement date: [[contact.spouse_retirement_date]]

12b. If No, Age your spouse would like to retire: [[contact.spouse_ideal_retirement_age]]

13. Main source of income: [[contact.main_income_source]]

13a. If Main source of income contains 'Salary,' Please provide household annual income: [[contact.main_income__current_employment_]]

13b. If Main source of income contains 'Pension,' Please provide Pension benefits amount: [[contact.main_income__pension_]]

13c. If Main source of income contains '401k,' Please provide social security amount: [[contact.main_income__social_security_]]

13d. If Main source of income contains 'Portfolio,' Please provide real estate amount: [[contact.main_income__real_estate_]]

13e. If Main source of income contains 'Other,' Please provide $$ amount: [[contact.main_income_source__other_]]

14. Any other sources of income (real estate, inheritance, annuities): [[contact.other_income__how_much_]]

15. Annually, how much money do you need to cover your lifestyle today? [[contact.how_much_money_do_you_need_to_cover_your_lifestyle_today___annually__]]

15a. Is this pre-tax or post-tax? [[contact.pre_tax_or_post_tax]]

16. Do you currently have a Mortgage? [[contact.do_you_currently_have_a_mortgage_]]

16a. If Yes, Monthly Payment: [[contact.mortgage_monthly_payment]]

16b. If Yes, How Many Years Remaining: [[contact.mortgage_how_many_years_remaining]]

17. Expected Social Security Benefits: [[contact.expected_social_security_benefits]]

17a. Spouses Expected Amount (if applicable): [[contact.social_security___spouses_expected_amount]]

18. How much do you anticipate withdrawing from your portfolio this year to support the above-listed goals? Annual amount: [[contact.expected_annual_withdrawal_needs_from_the_portfolio]]

19. Are there any short-term liquidity needs (home repair, vacations): if so, please provide the anticipated date and amount: [[contact.are_there_any_short_term_liquidity_needs__home_repair__vacations__]]

20. What are your bank account balances (checking, savings, CDs, money market)? [[contact.gps_bank_account_balances__checking__savings__cds__money_market__]]

21. Do you have non-retirement investment accounts (brokerage accounts, employee stock plans, etc.)? [[contact.do_you_have_non_retirement_investment_accounts__brokerage_accounts__employee_stock_plans__etc___]]

21a. If Yes, Please provide accounts/values: [[contact.non_retirement_investment_accounts_values]]

22. Do you have retirement accounts? (401k, 403b, 457, TSP) [[contact.do_you_have_retirement_accounts___401k__403b__457__tsp_]]

22a. If Yes, Please provide accounts/values: [[contact.retirement_account_values]]

23. Who are your beneficiaries? [[contact.who_are_your_beneficiaries_]]

24. Do you have an estate plan? [[contact.do_you_have_an_estate_plan_]]

24a. If Yes, Date of completion: [[contact.estate_plan_completion_date]]

25. Do you have a CPA? [[contact.do_you_have_a_cpa_]]

25a. If Yes, Name: [[contact.cpa_name]]

Please let us know if there is anything else you’d like to discuss during our meeting. [[contact.is_there_anything_else_i_should_know_]]