General Intake Form

Personal Information

Residential Address *

City

State

Country

Postal code

Housing Information

Monthly Mortgage or Rent Payment (if applicable)

$

Do you have equity in your primary residence or investment property? *

Yes

No

Estimated Equity Amount (if applicable)

$

Current Mortgage Balance or Amount Owed

$

Employment Information (W-2 Employees)

Employer Address

Job Title / Position

Do you have a 401(k)? *

Yes

No

Self-Employed / Business Owner Information (If Applicable)

Annual Gross Revenue (Before Expenses)

$

Do you have the last two (2) years of filed business tax returns?

Assets & Investment Capacity

How much cash do you currently have available to invest if you were making an investment today?

$

Do you have any of the following accounts with accessible funds? (Check all that apply)

Annuities

IRA(s)

Brokerage Accounts

Other Liquid Assets

Credit Profile

Estimated Credit Scores (to the best of your knowledge):

Experian

Have you had more than six (6) credit inquiries in the last six (6) months? *

Yes

No

Have you filed for or been discharged from bankruptcy in the last three (3) years? *

Yes

No

Banking Relationships

Where do you bank personally?

(Please list all banks and/or credit unions)

Bank 3

Where do you bank for your business (if applicable)

(Please list all banks)

Supporting Documents

Upload Your Credit Report

Upload Supporting Documents

Also you can forward the documents to [email protected]

To help us prepare a customized formula for our 30-minute meeting, please provide the specific information you would like us to review or calculate.