Q1: Full Name
(Required)
Date
(Required)
MM slash DD slash YYYY
Email
(Required)
Phone
(Required)
Will this proposal also cover your spouse/significant other?
(Required)
No
Yes
Person 2 (if applicable)
Full Name
(Required)
Email
(Required)
Phone
(Required)
Q2: Citizenship
(Required)
U.S.
U.S. Visa
Non-U.S. U.S. Ex-patriot
Q3: Current Marital Status
(Required)
Single
Married
Domestic Partnership
Widowed
Divorced
Q4: Dependents (Select all that apply)
(Required)
None
Biological / Foster / Adopted Children (ages 0 - 18)
Blended families (Your spouse has children ages 0-18)
Caregiver for elderly, disabled, special needs, handicapped, or dysfunctional (any age)
Q5: Total Household Income
(Required)
$100k or less
$101k to $250k
$251k or greater
Q6: Income Sources (Select all that apply)
(Required)
W-2 Wages and/or 1099 Wages ONLY
Plus passive income (rental, interest, dividend income)
Plus retirement income (social security, required minimum distributions, pension)
Q7: Debt (exclude mortgage and car loan)
(Required)
None
Credit cards, Student Loans, other debt
Tax Liens, Foreclosure, Bankruptcy
Q8: Total Debt (exclude mortgage and car loan)
(Required)
Less than $1k
$1k - $50k
$51k+
Q9: Asset Value (exclude home value)
(Required)
Less than $250k
$250k or $500k
$501k +
Q10: Type of Accounts (Select all that apply)
(Required)
Checking/Savings, Brokerage, IRA, 401k or other retirement plan
Individual Securities, Savings Bonds, Direct Mutual Funds
Closely held business, real estate, Trusts, REIT, or other
Q11: Asset Ownership (Select all that apply)
(Required)
Direct Ownership or Custodial Ownership
Owned jointly by 2 or more people
Indirect ownership: Company, trust, or other
Q12: Locations
(Required)
All in state of domicile
2 states or more
Some or all assets are outside the U.S.
Q13: Number of Investment Accts
(Required)
0-2
4-9
10+
Q14: Estate
(Required)
Legal Documents/Business Agreements are complete.
Legal Documents/Business Agreements Need Revision
No Legal Documents/Business Agreements in place
Q15: Health
(Required)
No Major Issues
High Blood Pressure, High Cholesterol, Diabetes, Other
Terminal illness, Permanent disability
Q16: Life changes (Select all that apply)
(Required)
None
Pending Marriage, Birth or Adoption of a Child
Relocation, Re-marriage, Inheritance, Pre/Post-marital or domestic agreements
Pending Divorce, recent death, pending retirement, transition out of corp.
Q17: Special Circumstances (Select all that apply)
(Required)
None
Child Support, Alimony, Disability, Early retirement buyout,
Stock Options, Structured Settlement, Trust Fund, Inheritance
Windfall Settlement, Personal Injury Settlement, Lottery Winnings
Q18: Services Sought (Select all that apply)
(Required)
Insurance Planning (Life/Long-Term Care/Annuities)
Investment Planning (Active Portfolio Management/Alternative Investments)
Retirement Income Planning (Mapping out income strategies for life after work)
Tax & Estate Planning (Tax Minimization/Wealth Transfer)
Business Planning (Buy/Sell, Benefits, Executive Compensation, Succession Planning)
InvestHER Fiduciary Solutions, LLC © 2006 - 2024. All Rights Reserved.
Success message!
Warning message!
Error message!
