Your Name: *
Your Name:
Date of Birth
Date of Birth
U.S. Citizen:
Spouse's Date of Birth
Spouse's Date of Birth
Home Address *
Home Address
Your Business Address
Your Business Address
2. Investment Objective
Speculative
Growth
Growth & Income
Income
Liquid
Including Real Estate, Investments, Savings
Including Mortgages, Credit Card Debt, Loans, Back Taxes
3. Children:
Date of Birth
Date of Birth
Home Address
Home Address
4. Miscellaneous:
Have you; your spouse or any of your children had a previous marriage?
Are you, your spouse or children the beneficiary of any trust or gift giving program?
Do you, your spouse, or your children anticipate an inheritance?
5. Current Plan:
Do you or your spouse have a will?
Have you or your spouse made gifts in excess of $11,000 to any one individual or entity?