Financial Planning Questionnaire

Name:
Address (Street, City, State, Zip Code):

Phone:
Email:
Marital Status: SingleMarriedDivorcedWidowed

Your Date of Birth (MM/DD/YYYY):

Spouse's Date of Birth (MM/DD/YYYY):

Your Occupation:

Spouse's Occupation:

Number of Children:

Children's Ages:

Combined Salary Range:
Under $50,000$50,000 to $100,000$100,000 to $250,000Over $250,000

What is your net worth?

How long have you lived in your present home?

Do you own it? YesNo

Do you own any other real estate? YesNo

If yes, what type?

Do you or your spouse have pensions? YesNo

Do you or your spouse have any other assets? YesNo

If yes, what other assets?

What are your concerns?

What are your hobbies or other interests?

Additional comments: