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Last Name
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Phone
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Email
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Preferred Contact Method
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Phone
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Financial Snapshot
What is your current annual income?
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< $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
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Do you currently own real estate? (check all that apply)
Yes (Primary Residence)
Yes (Investment Property/Properties)
No
Do you have any of the following? (check all that apply)
Retirement Accounts (401k, IRA, etc.)
Stocks/Bonds
Life Insurance
Business Ownership
Savings/Emergency Fund
Debt & Liabilities
What type of debt do you currently carry? (check all that apply)
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Mortgage(s)
Student Loans
Auto Loans
Credit Card Debt
Business Debt
Other
If you checked "Other" please specify below:
Are you current on all payments?
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Yes
No
Goals & Priorities
What are your top 3 financial goals over the next 12 months?
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What are your long-term wealth goals? (5–10 years)
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Which of the following are most important to you? (rank top 3)
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Financial Freedom
Passive Income
Debt Elimination
Real Estate Investing
Legacy/Generational Wealth
Tax Reduction Strategies
Business Growth
Risk & Mindset
How comfortable are you with financial risk?
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Very Comfortable
Somewhat Comfortable
Cautious
Very Risk Averse
How involved do you want to be in managing your wealth strategy?
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Immediately
Within 3 Months
Within 6–12 Months
Just Exploring
What resources, tools, or support would help you feel most confident moving forward?
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Is there anything else I should know about your financial situation, goals, or challenges?
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