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First Time Client Form / Quote Request --
(CONFIDENTIAL)
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* Indicates required question
1. You Full Name
*
Your answer
1.1 Your Date of Birth
Your answer
2. Spouse’s Name (If Married)
Your answer
2.1 Spouse's Date of Birth
Your answer
3.1 How many dependents do you have?
Your answer
3.2 All Dependent’s Names and Date of Birth
Your answer
4 Home Address (Street, City, State, Zip code)
*
Your answer
5 Phone / Mobile Phone
*
Your answer
6 Emails (For you and Spouse)
*
Your answer
8 Citizenship / Visa Status
Your answer
9 Occupation (you and your spouse)
Your answer
10 Gross Annual Household Income (Approx.) $
Your answer
11 Own a Primary Residence or Rent a house?
Own Residence
Rent
Other:
Clear selection
11.1 Value of Primary Residence or Monthly Rent
Your answer
12. Total Value of Non-retirement and Retirement Savings Accounts. Approx.
Choose
0 ~ $250,000
$250,000 ~$500,000
$500,000 ~ $1,000,000
$1,000,000 ~$2,000,000
$2,000,000 and $5,000,000
$5,000,000 and Above
13 Do you have or trade stocks or any investment securities?
*
No, I do not trade or have
Stocks, or Mutual Funds, ETF
Digital Currency (Bitcoin, Ethereum, Litecoin)
RSU (Restricted Stock Unit)
ESPP (Employer Stock Purchase Plan)
Exercise Stock Options (ISO / NQSO)
Required
13.1 If yes above, then how many investment (Non-Retirement) brokerage accounts do you have?
*
# of Accounts
0
1
2
3
4
5
6
7
8
9
10
14 Do you own any real estate property (other than your primary residence)?
*
No, I do NOT have.
Yes, Rental Property (see next question 14.1)
Yes, 2nd Home for Vacation or Other
Required
14.1 If you own a rental property above, Please provide Number (How many) , each Value ($), and Location (City, State) of Rental Properties
Your answer
15. Do you have any US Passive Investments (K-1) or Retirement Distributions?
*
No, I do not have any
Yes, K-1 from Partnership or LLC
Yes, K-1 from S-Corporation
Form 1099-R from Retirement accounts (IRA, Roth IRA, Pension)
Roth IRA Converson
Other:
Required
15.1 If Yes above, How many K-1s and Form 1099-R from Passive Investments or retirement funds?
Your answer
16 Do you have any Foreign bank accounts or Foreign Passive investments?
*
No, I do NOT have one
Yes, Foreign Bank Accounts, or Annuity, investment brokerage (see below 15.1)
Yes, Foreign Private Company (see below 15.1)
Other:
Required
16.1 If Yes Above, Total Number (How many accounts) and Total Value ($) of Foreign Bank Accounts or Foreign Investments
Your answer
17. Do you or your spouse run a business or self-employed?
*
NO, I do not have any business
Sole Proprietorship or Self-Employed
Corporation, LLC, Partnership (Please fill out "First Client Form--Business")
Other:
18 Do you have any specific (special) situations? or, Please explain and add your comments
Receive a letter from IRS
Moving from other state; multi-state income
acquired a rental property
sold a house or rental property
Divorce process
Married filing separate analysis
Sales / Exercise of Employer Stocks (ISO, NQSO)
Other:
18.1 If you have any specific special situations, then Please explain and add your comments
Your answer
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