Financial Fitness Checklist

My Personal Information

• First and Last Name
  OK First and Last Name is required
• Email
  OK Email is required
• Phone Number
  OK Phone Number is required

My Financial Goals

• What goals would you like to work towards in this consultation? Please select all that apply.

  • A complete financial analysis
  • Preparing for retirement
  • IRA strategies
  • Retirement plan rollover services
  • Set up lifetime pension
  • Tax favored annuities and/or investment strategies
  • Options to outpace inflation
  • Certificate alternatives
  • Life insurance planning
  • Legacy planning
  OK What goals would you like to work towards in this consultation? Please select all that apply. is required

My Current Situation

What does your life look like currently? Please select all that apply.

• What is your marital status?

  • Married
  • Widowed
  • Divorced
  • Single
  • Separated
  OK What is your marital status? is required
• Spouse/Partner's Name
  Optional OK Spouse/Partner's Name is required

• What is your family dynamic?

  • Children
  • No Children
  • Grandchildren
  OK What is your family dynamic? is required

• Do you own or rent your home?

  • Own
  • Rent
  OK Do you own or rent your home? is required

• Do you have a healthy savings? (Approx 6 months of living expenses)

  • Yes
  • No
  OK Do you have a healthy savings? (Approx 6 months of living expenses) is required

• Are you a business owner?

  • Yes
  • No
  OK Are you a business owner? is required

• What is your employment status?

  • Employed
  • Unemployed
  • Retired
  OK What is your employment status? is required
• If employed, employer name
  Optional OK If employed, employer name is required
• If retired, retirement date
  Optional OK If retired, retirement date is required
• Current Annual Income
  OK Current Annual Income is required