Financial Assessment Form (FAF)

The purpose of gathering this information is to Help organize your financial information in one location.

Our goal is to give you more BENEFITS, More OPTIONS, help you pay LESS in taxes today and in retirement, With LESS risk than you are currently and if possible taking WITHOUT taking money out of your pocket.

In order to do that, we think we can help find lazy/unproductive assets, to avoid taking extra money out of your pocket to fund your system

Find inefficiencies where money is leaving your control... unknowingly and unnecessarily (e.g., money spent on taxes, interest, high payments, fees or penalties you don't have to spend).

Identify "no market risk opportunities" within your existing Personal Economic Model where you could use the Financing Strategies we uncover through the process of working together.

All information submitted is strictly confidential. Rest assured your information is safe, secure & will not be shared with anyone without your permission.

Ready to get started?

Basic Information

First Name

Last Name

Date of birth

Phone

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (XXX) XXX-XXXX for assistance. You can reply STOP to unsubscribe at any time.

Home Address

Street Address

City

State

Postal code

Time Zone

I have a spouse or significant other

Yes

Spousal/ Significant Other Info

Spouse First Name

Spouse Last Name

Spouse Birthday

Spousal Phone Number

(000)-000-0000

Spouse Email

Do you have children?

Yes

Real Estate

Do You Own a Home?

Yes, I own a home

No, I do not own a home

If you own a home:

Year Purchased
Purchase Price
Remaining Loan
Current Value

Do you own other real estate, or do you consider yourself a real estate investor?

Yes I am a real estate investor

No, but I want to invest in real estate

I am setting up or have set up a First Position HELOC

Yes

No, but I would like to learn more

Account Values

Please Estimate the following values

Checking
Savings
Stocks
Bonds
401(k)/ Qualified
Alternative

Please describe other assets that complete your financial picture:

Pension, Social Security, and Future Income

What age do you plan to start Social Security?

I am expecting a pension

Yes

Annually, how much do you think your pension will be?

Future Income or Inheritance

Do you have any expected future income or inheritance?

E.g. Inheritance, sale of a business, company stock, etc.

Liabilities

Please Estimate Values:

Credit Card Debt
Auto Loans
Business/ Personal Loans
RV/ Boat Loans
Student Debt
Other Consumer Debt

After your monthly bills are paid, how much do you have left over each month?

Taxes

Please indicate filing status

On Last Years Taxes:

Please indicate last years combined/ total taxable income

Typically this is found on the bottom of your latest 1040 tax form

I received a tax refund last year

Yes

Check this box if you recieved a tax refund last year.

Approximately how much was your combined state and federal tax refund last year?

Will/ Trust

I have a will

Yes

What year was your will last reviewed?

I have a trust

Yes

What year was your trust last reviewed?

Financial Future Questions

Which aspects of your financial future is most important to you right now?

Paying Down Debt

Retirement Planning

Wealth Building

Wealth Transfer

What do you see as your greatest financial opportunities?

In your job, in your business, your part-time business, etc.

What are your biggest financial concerns?

What keeps you up at night?

How can we best help you?

Any other comments?

Anything financially we should be made aware of?

How did you hear about us/who referred you?

e.i. RYM, Financial Advisor, Friend, etc. (Please give a name, if you know it).