Business Name
*
Officers
1. Name / Date of Birth / Sex
2. Name / Date of Birth / Sex
3. Name / Date of Birth / Sex
4. Name / Date of Birth / Sex
Business Address
*
Entity Type
Sole Proprietorship
S- Corporation
LLC, Taxed as Sole Proprietorship
LLC, Taxed as S- Corporation
C-Corporation
Partnership
LLC, Taxed as C-Corporation
LLC, Taxed as Partnership
Other
Business Stage
Concept
Growth
Sale in (# years)
Start-up
Stable
Current Concerns
Key Person
Business Succession
Buy / Sell
Golden Handcuffs
Executive Bonus
Debt Elimination
Deferred Comp.
Tax Reduction
Banking
Business Cashflow Data
Annual Cash Flow: $
Minimum Monthly Cash Flow: $
Max. Monthly Cash Flow: $
Line of Credit?
Reserves on Hand: $
Retained Earnings $
Monthly Salary $
How bills are paid: LOC or cash
Do you expect a significant future change in cash flow?
Do you distribute bonuses?
Business Debt
1. Debt name / Amt / int % / min pmt / actual pmt
2. Debt name / Amt / int % / min pmt / actual pmt
3. Debt name / Amt / int % / min pmt / actual pmt
4. Debt name / Amt / int % / min pmt / actual pmt
5. Debt name / Amt / int % / min pmt / actual pmt
6. Debt name / Amt / int % / min pmt / actual pmt
7. Debt name / Amt / int % / min pmt / actual pmt
8. Debt name / Amt / int % / min pmt / actual pmt
9. Debt name / Amt / int % / min pmt / actual pmt
10. Debt name / Amt / int % / min pmt / actual pmt
Retirement Plan
Is there a business-sponsored retirement plan?
Who is included? owner, employee, both
Do you have any other plans (ie, key person/executive bonus)
Personal Monthly Contribution: $
Is there an employer match?
If so, what is the match?
Has a tax analysis been performed to optimize your current retirement plan
Outside investment options
1. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
2. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
3. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
4. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
5. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
6. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
7. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
8. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
9. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
10. Institution / Acct type / Value $ / Monthly contrib / Avail yes or no
Life Insurance benefits
Overall health - preferred, standard, substandard
Tobacco user - yes/no
Type: Permanent / term / employer
Premium
Death Benefit
Cash value
File upload
Agent of record (who is your agent? or no one)
*
How did you find us?
*
Referral
Agent
TV
Website
LinkedIn
Facebook
Tiktok
Instagram
Other
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