New Client Profile

» Required Fields



Personal Information Client:		required fields *
» * Full Name:
Nickname:
Age:
	Client-Previously Married (check if yes)
» * E-Mail:


Spouse:
Full Name:
Age:
	Previously Married (check if yes)
E-mail:

Home Phone:
Home Address:
» * City:
» * State:
Zip:


Work Information Client:
Employer:
Type of Business:
Position:
Years Employed:
Business Phone:
Business Address:
City:
State:
Zip:
Best Time to Call Home:
at Work:
May we call you at work?


Spouse:
Employer:
Type of Business:
Position:
Years Employed:
Business Phone:
Business Address:
City:
State:
Zip:



Other Family Members


Name:
Relationship:
Home Address:
City:
State:
Zip:
Age:

Name:
Relationship:
Home Address:
City:
State:
Zip:
Age:



The Following Questions Will Help Us In Our Planning


1.) What do you anticipate your income for the next three years to be?
		Client:
This Year: $
Next Year: $
Year After: $


		Spouse:
This Year: $
Next Year: $
Year After: $


2.) At what age do you wish to retire?


3.) Will the untimely death of parents or their need for care affect your finances?

A. Current age of client's parents:

B. Current age of spouse's parents:

C. If they will need finanical help, how much help and when do you anticipate this need will begin?
$
Year:

D. Is an inheritance likely in the future?

4.) The following is a list of various advisors which you may have. Indicate if you do, and rate them from 1 to 5 as to your satisfaction with five being higest:

A. Attorney:


B. Accountant:


C. Insurance Person:


D. Stockbroker:


E. Financial Planner:


5.) Which one of the above, or someone else, do you turn to most for help in making financial decisions?
If other, please specify:


6.) How do you rate your overall satisfaction with how you and/or others have managed your money until now?

7.) The following is a list of various financial goals. Rate each one in terms of your own priorities with five being highest.

Get out of debt:

Future-travel:

Financial-Goals-Save for home:

Giving:

Funding College:

Emergency Funds:

Retirement Funds:

Other:

If other, please specify:


8.) Do you anticipate buying and/or selling a home in the next year or two?


9.) What is your most pressing financial problem that you need to address?


10.) What would you estimate your net worth to be?


Do you have any further comments?

Press submit and you're done!

Prairie Investment Advisors, LLC

1813 North Mill Street, Suite G

Naperville, IL 60563

Phone: 630-778-8785

•

Fax: 630-778-9854

www.PrairieFS.com

•

info@prairiefs.com