The first step in your Needs Analysis is this Client Information Questionnaire (CIQ). It is a series of short questions that enable us to obtain a brief overview of your personal and business (if appropriate) situation.

This information will help your Advisor provide you with proactive planning recommendations.

You can be assured that your answers to the questions remain 100% confidential at all times.

Once your have completed the Form, you will be directed to a calendar request to schedule time with Jennifer to review the results and discuss your Options.

We appreciate and value your trust in us and look forward to proactively working with you for many years to come.

Primary Contact Information

First Name *

Last Name *

What is your Gender? *

Female

Male

Your Date of Birth *

Tobacco Use *

Tobacco User

Non-Tobacco User

Spouse/Partner Contact Information

Spouse/Partner First Name

Spouse/Partner Last Name

Spouse/Partner's Gender

Female

Male

Spouse/Partner's Date of Birth

Tobacco Use spouse

Tobacco User

Non-Tobacco User

Minor Children Contact Information

Do You have Minor Children? *

Yes

please comment below the Gender and Ages of Minor Children.

Minor Children Gender(s) and Age(s)

Additional Comments:

Primary Contact Email Address *

Best Phone to Reach You *

City *

State Where You Live *

Your Key Advisors

Our goal is to provide you with proactive and holistic advice. To allow us to be truly supportive it is helpful to know who your regard and currently rely on as key advisors.

Please complete the information below for each of your "key advisors". If you have none please type N/A and continue. The rating scale is 1 for poor to 5 for excellent.

1a. Key Advisor and Profession (banker, insurance, accountant, attorney, CFP, Etc.)

Personal Rating for Advisor above in 1a.

BadGood

1b. Key Advisor and Profession (banker, insurance, accountant, attorney, CFP, Etc.) (copy)

Personal Rating for Advisor above in 1b.

BadGood

1c. Any other Comments regarding Key Advisors?

Business Interest (if applicable)

2a. Do you own or have financial interest in a business?

Yes

2b. If Yes, then we can schedule time following our initial meeting to discuss the Business Strategies Solutions we offer Small business owners. Would you be interested in Learning more?

Yes

Maybe

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