Core Questionnaire Client Name Date Client Information Last Name First Name Date of Birth Occupation Spouse Information Last Name First Name Date of Birth Occupation Child Information Child 1 Last Name First Name Date of Birth Child 2 Last Name First Name Date of Birth Child 3 Last Name First Name Date of Birth Your Address Address Line 1 Address Line 2 City State Zip Email Phone Individual Questions 1. Over the next 3 years do you expect your income to increase, decrease, or stay the same? Increase Decrease Stay the same 2. Do you have any of the following types of accounts? Check all that apply IRA or Roth IRA 401k or 403b Investment Account (wealth Management) Profit Sharing Plan Other Investments 3. Do you have any of the following types of asset classes? Check all that apply Commercial Real Estate Personal Real Estate Alternative Investments Business Investments Stock/ Bonds Angel Other (Please specify) Other: 4. Are there specific areas of financial planning you would like our office to help you with? Check all that apply Business Planning Retirement Planning Tax Strategies Wealth Management (Stock and Bonds) Social Security Planning College Planning Estate Planning Other 5. Are you currently looking for any other professional relationships? Check all that apply Business Attorney Estate Planning Attorney Real Estate Professional Banker CPA Other Business Questions 6. Do you have a business? Yes No 7. What type of business? 8. Please list your company's name, address and website: Address Line 1 Address Line 2 City State Zip Website URL 9. What does your company do? 10. How many companies do you own? 11. Please check the entity type for your business: C-Corp S-Corp LLC LTD partnership Sol-Proprietorship Other 12. Do you have any business partners? Yes No 13. How many business partners do you have? 14. What percentage of the company do you own? 15. How many employees does this company have? 16. Do you have a written business plan? When was it last updated? 17. Do you have a buy/sell agreement in place? Yes No 18. When was the most recent company valuation done? Within 2 years 2-5 years Never 19. Do you have any of the following types of accounts? Qualified Company Plan (401k, Defined Benefit Plan, etc.) Profit Sharing Plan IRA or Roth IRA ESOP Section 79 Plan Stock Account Other 20. What are your main business concerns? Reduce Taxes Company Growth Retirement Planning Succession Planning Key Employee Retention Other 21. Please provide any other updates or details that you feel would be relevant in our planning efforts moving forward. Submit Powered by Core Partners
