Plan Creation for New Contact "*" indicates required fields Advisor Name* Casey Short Tony Rizzo Jay Beerley David McEntire Dan Thomas Name* First Last Date of Birth* MM slash DD slash YYYY Gender* Male Female Email address PhoneAddress Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Marital Status Married Divorced Single Widow/ Widower Spouse's Name First Last Spouse's Date of Birth MM slash DD slash YYYY Spouse's E-mail address Spouse's PhoneRetired? Yes No Estimated Retirement Year Employed? Yes No Occupation Employer Employer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Does client have Estate Documents? Yes No Estate DocumentsTypeAge Add RemoveIs client Active Military? Yes No Assets - Select all that Apply Current Retirement Plan (401k, 403b, etc) Old Retirement Plan (401k, 403b, etc) IRA Roth IRA Brokerage Account Checking and Savings Home Auto Other AssetsOwner/Custodian of Current PlanAmountNotes Add RemoveUse the plus icon to add rows. AssetsOwner/Custodian of Old PlanAmountNotes Add RemoveUse the plus icon to add rows. AssetsOwner/Custodian of IRAAmountNotes Add RemoveUse the plus icon to add rows. AssetsOwner/Custodian of Roth IRAAmountNotes Add RemoveUse the plus icon to add rows. AssetsOwner/Custodian of Brokerage AccountAmountNotes Add RemoveUse the plus icon to add rows. AssetsChecking and Savings Institution(s)AmountNotes Add RemoveUse the plus icon to add rows. AssetsHomeValueNotes Add RemoveUse the plus icon to add rows. AssetsAutoValueNotes Add RemoveUse the plus icon to add rows. AssetsOtherValueNotes Add RemoveUse the plus icon to add rows. Liabilities - Select all that Apply Mortgage Home Line of Credit Auto Loan School Loan Credit Card (if balance carried over) Other LiabilitiesMortgage AmountMonthly PaymentInterest RatePayoff YearNotes Add RemoveUse the plus icon to add rows. LiabilitiesHome Line of CreditMonthly PaymentInterest RatePayoff YearNotes Add RemoveUse the plus icon to add rows. LiabilitiesAuto Loan AmountMonthly PaymentInterest RatePayoff YearNotes Add RemoveUse the plus icon to add rows. LiabilitiesSchool Loan AmountMonthly PaymentInterest RatePayoff YearNotes Add RemoveUse the plus icon to add rows. LiabilitiesCredit Card BalanceMonthly PaymentInterest RateNotes Add RemoveUse the plus icon to add rows. LiabilitiesOtherMonthly PaymentInterest RateNotes Add RemoveUse the plus icon to add rows. Net Worth (not including primary residence) $0 - $14,999 $15,000 - $49,999 $50,000 - $99,999 $100,000 - $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 - $1,999,999 $2,000,000 + Gross Income - Select All That Apply Work Spouse's Work Social Security (if currently receiving) Social Security (Estimated at FRA) Spouse's Social Security (if currently receiving) Spouse's Social Security (Estimated at FRA) Rental Property Income Annuity/Pension Payments Investment Income Inheritance Income Disability Payments Other Work IncomeGross AmountNotes Add RemoveIncomeSpouse's Work Income Gross AmountNotes Add RemoveIncomeSocial Security Income Gross AmountNotes Add RemoveEstimated Social Security Income at FRAGross AmountNotes Add RemoveSpouse's Social Security IncomeGross Income AmountNotes Add RemoveSpouse's Estimated Social Security Income at FRAGross IncomeNotes Add RemoveRental Property IncomeRental Property Gross IncomeRental Property Net IncomeNotes Add RemoveInvestment IncomeAmountNotes Add RemoveIncomeAnnuity/Pension Payment AmountNotes Add RemoveInheritance IncomeAmountNotes Add RemoveDisability PaymentsAmountNotes Add RemoveOther IncomeOther Income AmountNotes Add RemoveSavingsEstimated Monthly General SavingsNotes Add RemoveAnnual Household Income 0 - $24,999 $25,000 - $49,999 $50,000 - $99,999 $100,000 - $249,999 $250,000 + SavingsEstimated Monthly Retirement SavingsNotes (i.e. 401k, IRA, etc) Add RemoveEstimated Monthly Essential Expenses (Non-discretionary)Core living expenses like food, taxes, rent, insurance, utilities, etc. Estimated Monthly Lifestyle Expenses (Discretionary)Expenses to enhance your lifestyle like travel, and other interests. Current Risk Tolerance Conservative Conservative Growth Balanced Moderate Growth Growth Determine from New Risk Profile Investment Objectives - Check All that Apply Growth Income Safety of Principal Liquidity Tax Advantaged Please indicate past experience with each asset class (check all that apply) Stocks Bonds CD's Real Estate Employer Plans Life Insurance Annuities Other Number of years with stocks Less than 1 year 1 - 5 years 5 + years Number of years with bonds Less than 1 year 1 - 5 years 5 + years Number of years with CD's Less than 1 year 1 - 5 years 5 + years Number of years with Real Estate Less than 1 year 1 - 5 years 5 + years Number of years with Employer Plans Less than 1 year 1 - 5 years 5 + years Number of years with Life Insurance Less than 1 year 1 - 5 years 5 + years Number of years with Annuities Less than 1 year 1 - 5 years 5 + years Other Asset Class Source of Funds for Potential Investment (Check all that apply) Retirement Savings Cash Reserves Inheritance Other Other source of funds Industry and Other Affiliations Check if contact / client or anyone of interest on the account is a politically exposed person. Check if contact / client is an officer, director or 10% (or more) shareholder in a publicly traded company. Check if this is a private banking account or a Foreign Financial Institution. Name and address of firm or CUSIP symbol How did new contact hear about us? Existing Client Referral Unsolicited Solicited Other Referring Client Name Name of Person Referring Additional Information Seminar InformationDateLocationPresenter Add RemoveAdditional Notes or Instructions Δ « Back to Workflow Seeds
