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information form
Personal Information Form
Prospective clients should please complete this form
Did someone refer you to us? Please tell us who.
Client Legal Name
First Name
Middle Name
Last Name
Also Known As/Prefer to be Called
Maiden name (if applicable)
Marital Status
Please Select
Single
Married
Divorced
Widowed
Do you have children?
Please Select
Yes
No
Number of Children
US Citizen
Please Select
Yes
No
Date of Birth
-
Month
-
Day
Year
Date
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Yes
No
It is okay to communicate with me via my E-mail address
Cell Phone Number
Do you have any of the following?
Will
Designated Standby Guardian for Minor Children
Trust
Power of Attorney
Health Care Proxy
Living Will
Life Insurance
None of the above
If you checked yes to any of the above, please provide details and please upload copies of existing documents using the Document Upload Section at the end of this form.
Spouse Information
Spouse Legal Name
First Name
Middle Name
Last Name
Former Spouse Name
First Name
Middle Name
Last Name
Date of Divorce
-
Month
-
Day
Year
Date
Deceased Spouse Date of Death
-
Month
-
Day
Year
Date
Spouse Also Known As/Prefer to be Called
Spouse Maiden name (if applicable)
Spouse US Citizen
Please Select
Yes
No
Spouse Date of Birth
-
Month
-
Day
Year
Date
Spouse Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse Email
example@example.com
Yes
No
It is okay to communicate with my spouse via their E-mail address
Spouse Cell Phone Number
Does your spouse have any of the following?
Will
Designated Standby Guardian for Minor Children
Trust
Power of Attorney
Health Care Proxy
Living Will
Life Insurance
None of the above
If you checked yes to any of the above, please provide details and please upload copies of existing documents using the Document Upload Section at the end of this form.
Date of Marriage
-
Month
-
Day
Year
Date
Location of Marriage
Family Information
Are any of your children minors?
Yes
No
Child 1 Name
First Name
Middle Name
Last Name
Child 1 Date of Birth
-
Month
-
Day
Year
Date
Child 1 Comments (from a prior marriage; special needs, etc.):
Child 2 Name
First Name
Middle Name
Last Name
Child 2 Date of Birth
-
Month
-
Day
Year
Date
Child 2 Comments (from a prior marriage; special needs, etc.):
Child 3 Name
First Name
Middle Name
Last Name
Child 3 Date of Birth
-
Month
-
Day
Year
Date
Child 3 Comments (from a prior marriage; special needs, etc.):
Child 4 Name
First Name
Middle Name
Last Name
Child 4 Date of Birth
-
Month
-
Day
Year
Date
Child 4 Comments (from a prior marriage; special needs, etc.):
Child 5 Name
First Name
Middle Name
Last Name
Child 5 Date of Birth
-
Month
-
Day
Year
Date
Child 5 Comments (from a prior marriage; special needs, etc.):
Child 6 Name
First Name
Middle Name
Last Name
Child 6 Date of Birth
-
Month
-
Day
Year
Date
Child 6 Comments (from a prior marriage; special needs, etc.):
Child 7 Name
First Name
Middle Name
Last Name
Child 7 Date of Birth
-
Month
-
Day
Year
Date
Child 7 Comments (from a prior marriage; special needs, etc.):Type a question
Child 8 Name
First Name
Middle Name
Last Name
Child 8 Date of Birth
-
Month
-
Day
Year
Date
Child 8 Comments (from a prior marriage; special needs, etc.):
Professional Contacts
CPA
First Name
Middle Name
Last Name
Title/Position, @Company Name
Email
example@example.com
Phone Number
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Insurance Agent
First Name
Middle Name
Last Name
Title/Position, @Company Name
Email
example@example.com
Phone Number
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Financial Advisor
First Name
Middle Name
Last Name
Title/Position, @Company Name
Email
example@example.com
Phone Number
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Attorney
First Name
Middle Name
Last Name
Title/Position, @Company Name
Email
example@example.com
Phone Number
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other Information
Estimated Net Worth
Please Select
Up to $100,000
Between $100,000-$1,000,000
Between $1,000,000-$10,000,000
Greater than $10,000,000
Any additional relevant information
Document Upload Section
Upload documents including photo ID, financial documents, etc.
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