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Info Request Form

Success! We will reach out to you shortly with any follow up questions and get you scheduled for your next meeting! Welcome to the Help First Journey!

1
Welcome
2
Bio
3
Contact info
4
Family
5
Meetings
6
Confidence
7
Goals
8
Residence
9
Assets
10
Assets-Non-Retirement
11
Liabilities
12
Income
13
Planned savings
14
Expenses
15
Upload Documents

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Information Request Form

We appreciate your time, energy, and patience completing this form and gathering your documents. We realize it’s no small feat! This takes about 30-45 minutes.

Biographical Info

*Full Name

Date of birth

Primary email address

Secondary email address

Primary Residence

Street

Street 2

City

State

ZIP

Phone contact

Cell phone number

Home phone number

Work phone number

Employment

Job description

Employer

Any of these apply?

Non-US Citizen

Divorced/prior marriage

Widow/widower

Blended family

I have a living/revocable trust

Are you married?

Yes

Your spouse/partner's information (optional)

Name

Date of birth

Secondary Email

Phone Number

Any background or information we should be aware of with regards to how you and your spouse handle your finances?(eg. Combined, separate, division of the financial duties, etc.)

How many children?

Your child's info

Name

Date of Birth

Tell us about any specific goals you have around providing for your children? (education funding, financial assistance getting started in life, weddings, etc.)

Your children's info

First child

Name

Date of birth

Second child

Name

Date of birth

Third child

Name

Date of birth

Tell us about any specific goals you have around providing for your children? (education funding, financial assistance getting started in life, weddings, etc.)

Your children's info

First child

Name

Date of birth

Second child

Name

Date of birth

Tell us about any specific goals you have around providing for your children? (education funding, financial assistance getting started in life, weddings, etc.)

Your children's info

First child

Name

Date of birth

Second child

Name

Date of birth

Third child

Name

Date of birth

Fourth child

Name

Date of birth

Tell us about any specific goals you have around providing for your children? (education funding, financial assistance getting started in life, weddings, etc.)

Your children's info

First child

Name

Date of birth

Second child

Name

Date of birth

Third child

Name

Date of birth

Fourth child

Name

Date of birth

Fifth child

Name

Date of birth

Tell us about any specific goals you have around providing for your children? (education funding, financial assistance getting started in life, weddings, etc.)

How many grandchildren?

Your grandchildren's info

Your first grandchild's info

Name

Date of birth

Your second grandchild's info

Name

Date of birth

Your third grandchild's info

Name

Date of birth

Tell us about any specific goals you have around providing for your grandchildren? (education funding, financial assistance getting started in life, weddings, etc.)

Your grandchildren's info

Your first grandchild's info

Name

Date of birth

Your second grandchild's info

Name

Date of birth

Your third grandchild's info

Name

Date of birth

Your fourth grandchild's info

Name

Date of birth

Tell us about any specific goals you have around providing for your grandchildren? (education funding, financial assistance getting started in life, weddings, etc.)

Your grandchildren's info

Your first grandchild's info

Name

Date of birth

Your second grandchild's info

Name

Date of birth

Your third grandchild's info

Name

Date of birth

Your fourth grandchild's info

Name

Date of birth

Your fifth grandchild's info

Name

Date of birth

Tell us about any specific goals you have around providing for your grandchildren? (education funding, financial assistance getting started in life, weddings, etc.)

Your grandchildren's info

Your first grandchild's info

Name

Date of birth

Your second grandchild's info

Name

Date of birth

Tell us about any specific goals you have around providing for your grandchildren? (education funding, financial assistance getting started in life, weddings, etc.)

Your grandchild's info

Name

Date of birth

Tell us about any specific goals you have around providing for your grandchild? (education funding, financial assistance getting started in life, weddings, etc.)

Please rank your meeting preferences (1 star-least preferable to 5 stars-most preferable)

Zoom video meeting

Office visit

House call

Phone conference

How comfortable are you with your finances? (Scale of 1-10)

Can you explain more about why you gave yourself that rating?

Do you have any urgent financial needs, deadlines, stock vesting, other decisions that are urgent?

Please explain in more detail below. Thank you.

Tell us a little about your goals…if your plans are successful, what do you want your life to look like in:

20 years

10 years

5 years

Any specific goals, questions or factors you'd like addressed or discussed as part of this process?

Tell us about your primary residence

Own

Rent

Residence rented

Monthly payment

Any other information you'd like to share about your home?Saving for a downpayment to buy a house, our lease is up in 3 months, etc

Residence owned

Monthly payment

Approximate value

Purchase price

Mortgage balance

Mortgage rate

Property Tax

Homeowners Insurance Annual cost

Date of purchase

Term Length, Fixed or Variable?eg. 30 year-Fixed

Any other information you'd like to share about your home?Remodeling, put 50,000 into it, want to sell, etc

Retirement Accounts(401K, ROTH, IRA, Simple IRA, SEP IRA, HSA, etc)

One Retirement Account

Account Owner

Account Type

Balance

Custodian

Notes

Two Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Three Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Four Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Five Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Six Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Seven Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Eight Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Nine Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Ten Retirement Accounts

Account Owner

Account Type

Balance

Custodian

Notes

Assets continued...

Non-retirement accountsChecking, Savings, Trust, Individual Brokerage,etc

Non-retirement account

Account Owner

Account Type

Balance

Custodian

Notes

Two non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Three non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Four non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Five non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Six non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Seven non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Eight non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Nine non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Ten non-retirement accounts

Account Owner

Account Type

Balance

Custodian

Notes

Insurance & Annuities

One policy