New Client Info Tell us about yourself so we can begin our journey together. "*" indicates required fields Step 1 of 3 - Personal Information 33% Name* First Middle Last Date of Birth* Primary Email Address* Secondary Email Address (if applicable) Cell Phone*Home Phone (if applicable)Physical Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a separate mailing address?*NoYesMailing Address (If different from physical address) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employment Type*Employed (W2)Self-Employed (1099)HomemakerRetiredOtherEmployer Name*Approximate Years with EmployerOccupation*Employer Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Are you affiliated with any FINRA securities firm? Yes No Are you a 10% shareholder, director, or policy-making officer for any publicly traded company? Yes No Do you have a spouse/partner?*YesNo Spouse/Partner* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Spouse Date of Birth* Spouse Cell Phone*Spouse Primary Email Address* Spouse Secondary Email Address (if applicable) Spouse/Partner Employment Information*Employed (W2)Self-Employed (1099)UnemployedHomemakerRetiredEmployerApproximate Years with EmployerOccupationSpouse Work Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business PhoneDo you have any children? Yes No Child(ren) InformationFirst NameLast NameDate of Birth Add Remove 1. I plan to begin taking money from my investments in...* A. 1 year or less B. 1 - 2 years C. 3 - 5 Years D. 6 - 10 Years E. 11 - 15 years F. More than 15 years 1b. (Spouse/Partner) I plan to begin taking money from my investments in...* A. 1 year or less B. 1 - 2 years C. 3 - 5 Years D. 6 - 10 Years E. 11 - 15 years F. More than 15 years 2. As I withdraw money from these investments, I plan to spend it over a period of...* A. 2 years or less B. 3 - 5 years C. 6 - 10 years D. 11 - 15 years E. More than 15 years 2b. (Spouse/Partner) As I withdraw money from these investments, I plan to spend it over a period of...* A. 2 years or less B. 3 - 5 years C. 6 - 10 years D. 11 - 15 years E. More than 15 years 3. When making a long-term investment, I plan to keep the money invested for...* A. 1 - 2 years B. 3 - 4 years C. 5 - 6 years D. 7 - 8 years E. More than 8 years 3b. (Spouse/Partner) When making a long-term investment, I plan to keep the money invested for...* A. 1 - 2 years B. 3 - 4 years C. 5 - 6 years D. 7 - 8 years E. More than 8 years 4. I would describe my knowledge of investments as:* A. None B. Limited C. Good D. Extensive 4b. (Spouse/Partner) I would describe my knowledge of investments as:* A. None B. Limited C. Good D. Extensive 5. From September 2008 through November 2008, stocks lost more than 31% of their value. If I owned a stock investment that lost 31% of its value in three months, I would ...(If you owned stocks during this period, please select the answer that matches your actions at that time.)* A. Sell all of the remaining investment B. Sell some of the remaining investment C. Hold on to the investment and sell nothing D. Buy more of the investment 5b. (Spouse/Partner) From September 2008 through November 2008, stocks lost more than 31% of their value. If I owned a stock investment that lost 31% of its value in three months, I would ...(If you owned stocks during this period, please select the answer that matches your actions at that time.)* A. Sell all of the remaining investment B. Sell some of the remaining investment C. Hold on to the investment and sell nothing D. Buy more of the investment 6. Generally, I prefer an investment with little to no up or downs in value, and I am willing to accept the lower returns these investments may make* A. I strongly disagree B. I disagree C. I somewhat agree D. I agree E. I strongly agree 6b. (Spouse/Partner) Generally, I prefer an investment with little to no up or downs in value, and I am willing to accept the lower returns these investments may make* A. I strongly disagree B. I disagree C. I somewhat agree D. I agree E. I strongly agree 7. When the market goes down, I tend to sell some of my riskier investments and put the money in safer investments* A. I strongly disagree B. I disagree C. I somewhat disagree D. I agree E. I strongly agree 7b. (Spouse/Partner) When the market goes down, I tend to sell some of my riskier investments and put the money in safer investments* A. I strongly disagree B. I disagree C. I somewhat disagree D. I agree E. I strongly agree 8. Based on only a brief conversation with a friend, coworker, or relative, I would buy their recommended investment* A. I strongly disagree B. I disagree C. I somewhat agree D. I agree E. I strongly agree 8b. (Spouse/Partner) Based on only a brief conversation with a friend, coworker, or relative, I would buy their recommended invesment* A. I strongly disagree B. I disagree C. I somewhat agree D. I agree E. I strongly agree 9. From September 2008 through October 2008, bonds lost nearly 4% of their value. If I owned a bond investment that lost almost 4% of its value in two months, I would...(If you owned bonds during this period, please select the answer that matches your actions at that time.)* A. Sell all of the remaining investment B. Sell some of the remaining investment C. Hold on to the investment and sell nothing D. Buy more of the investment 9b. (Spouse/Partner) From September 2008 through October 2008, bonds lost nearly 4% of their value. If I owned a bond investment that lost almost 4% of its value in two months, I would...(If you owned bonds during this period, please select the answer that matches your actions at that time.)* A. Sell all of the remaining investment B. Sell some of the remaining investment C. Hold on to the investment and sell nothing D. Buy more of the investment 10. The chart below shows the highest one-year loss and the highest one-year gain on three different hypothetical investments of $1,000,000. Given the potential gain or loss in any one year, I would invest my money in...* A. Investment A B. Investment B C. Investment C 10b. (Spouse/Partner) The chart below shows the highest one-year loss and the highest one-year gain on three different hypothetical investments of $1,000,000. Given the potential gain or loss in any one year, I would invest my money in...* A. Investment A B. Investment B C. Investment C 11. My current and future income sources (such as salary, Social Security, pension) are...* A. Very unstable B. Unstable C. Somewhat stable D. Stable E. Very stable 11b. (Spouse/Partner) My current and future income sources (such as salary, Social Security, pension) are...* A. Very unstable B. Unstable C. Somewhat stable D. Stable E. Very stable 12. When it comes to investing in stock or bond mutual funds (or individual stocks or bonds), I would describe myself as...* A. Very inexperienced B. Somewhat inexperienced C. Somewhat experienced D. Experienced E. Very experienced 12b. (Spouse/Partner) When it comes to investing in stock or bond mutual funds (or individual stocks or bonds), I would describe myself as...* A. Very inexperienced B. Somewhat inexperienced C. Somewhat experienced D. Experienced E. Very experienced 13. You understand the value of investments will fluctuate over time, depending on the amount of risk taken. What is the approximate loss in any one-year period that you would be willing to accept before deciding to change your investments?* A. Less than (5%) B. (5%) to (10%) C. (10%) to (15%) D. (15%) to (25%) E. (25%) or more 13b. (Spouse/Partner) You understand the value of investments will fluctuate over time, depending on the amount of risk taken. What is the approximate loss in any one-year period that you would be willing to accept before deciding to change your investments?* A. Less than (5%) B. (5%) to (10%) C. (10%) to (15%) D. (15%) to (25%) E. (25%) or more 14. Consider two different investments: Investment A, which provides an average annual return of 5% with a minimal risk of loss of value, and Investment B, which provides an average annual return of 10% and a potential loss of 25% or more in any year. How would you divide your investment dollars?* A. 100% in Investment A and 0% in Investment B B. 80% in Investment A and 20% in Investment B C. 50% in Investment A and 50% in Investment B D. 20% in Investment A and 80% in Investment B E. 0% in Investment A and 100% in Invesment B 14b. (Spouse/Partner) Consider two different investments: Investment A, which provides an average annual return of 5% with a minimal risk of loss of value, and Investment B, which provides an average annual return of 10% and a potential loss of 25% or more in any year. How would you divide your investment dollars?* A. 100% in Investment A and 0% in Investment B B. 80% in Investment A and 20% in Investment B C. 50% in Investment A and 50% in Investment B D. 20% in Investment A and 80% in Investment B E. 0% in Investment A and 100% in Invesment B 15. When I invest my money, I am :* A. Most concerned about my investment losing value B. Equally concerned about my investment losing or gaining value C. Most concerned about my investment gaining value 15b. (Spouse/Partner) When I invest my money, I am :* A. Most concerned about my investment losing value B. Equally concerned about my investment losing or gaining value C. Most concerned about my investment gaining value Do you have a budget that you regularly follow?* Yes No Do you have a Long Term Care (LTC) policy, life insurance outside of work, and/or disability coverage outside of work?* Yes No ListInsured's NameType of Coverage (LTC/Life/Disability)Amount of Coverage Add RemoveDo you have a Will?* Yes No
