Client Assessment Form We're excited to learn more about your goals and needs. Please complete our Client Assessment Form to help us better understand your specific needs and provide you with tailored services. We're here to help you succeed! Language English (US) Spanish (Latin America) Before you begin, be aware you will be asked for information regarding the topics listed below. Please DO NOT provide any private information such as Social Security numbers or Account Numbers. Back Next Personal Tell us about yourself and your family. Your Name First NameLast Name Date of Birth /Month /DayYearDate Phone Number Please enter preferred contact number. Email example@example.com Desired Retirement Age What age would you like to retire? Desired Retirement Income How much MONTHLY income would you need in retirement? Back Next Spouse/Partner Tell us about yourself and your family. Spouse/Partner First NameLast Name Date of Birth /Month /DayYear Phone Number Please enter preferred contact number. Email example@example.com Desired Retirement Age Desired Retirement Age for your spouse/partner Desired Retirement Income Desired MONTHLY Retirement Income for your spouse/partner? Back Next Children Tell us about yourself and your family. Do you have children? Please Select No Yes Children's Age(s) Back Next Goals Tell us about your current and future goals. Goals Eliminate DebtIncrease SavingsReduce TaxesEducational CostsRetirement PlanningEstate PlanningWills/TrustAsset ProtectionLeave InheritanceBuy a HomeTravelOther Back Next Average Net Monthly Income Tell us about your AVERAGE monthly income after taxes. Income Back Next Real Estate Tell us about your properties, if any. Do you Own/Rent your home? Please Select Own Home Rent Home Other Property Information Do you wish to buy a home within 5 years? Please Select Yes No Back Next Debts List any outstanding debts other than mortgages. This includes car loans, student loans, credit cards, personal loans, business loans, etc. Include AVERAGE monthly amounts where possible. Current Debts Back Next Savings/Investments Tell us about your financial assets such as checking, savings, or investment accounts. Cash/Investments Back Next Life Protection Tell us about your life insurance policies, if any. Life Insurance Policies Back Next Upcoming changes Tell us about any upcoming changes, if any. Do you expect a significant change in cash flow or expenditures in the near future? Please Select Yes No Please describe your expected changes. Back Next Almost done... Thank you for taking the time to complete this valuable information. You are on your way to changing your life for the better! Press the Submit button below to complete the process. Submit Should be Empty: Download a printable version (English). Descargue una versión imprimible (español).