Peak Wealth Confidential Client Profile

Client Name: *

How did you find out about us? *

Do you have a meeting booked yet? *

If not, please copy and paste this link and book now: https://go.oncehub.com/Peakwealth

Address: *

Client Date of Birth: * +

Cell Phone: *

Email *

Spouse Name:

Spouse Date of Birth: +

Email

Children Names and Dates of Birth:

Save & Return

Use an account to return to saved work.

Client Income: *

Spouse Income:

Client Social Security amounts- @62, @67, and @70 (please take values from your SS statement which can be found on ssa.gov: *

Spousal Social Security amounts- @62, @67, and @70:

Please provide any pension details, if applicable:

Please upload a pdf copy of your latest tax return (Form 1040)

Save & Return

Use an account to return to saved work.

Please list Real Estate Property and Value:

Please list any Mortgage balance, start date, #years, interest rate, and payment (principal and interest only - do not include escrow): *

Please list other debts,#years, interest rate and payment (Home Equity, Student Loan, Credit Card, Car loan, etc):

Please provide bank account values: *

Please provide 401k details for Client and Spouse: Current Value, deferral rate, company match rate:

Please upload Client and Spouse 401k Statement;

Please provide details about Client and Spouse IRA or Roth IRA accounts - all other retirement accounts - registration/current value/institution:

Please upload all client and spouse IRA/Roth IRA statements:

Non-Retirement Accounts - please provide current value, registration info (TOD, JOINT, Trust, etc) and institution where money is presently held?

Please upload all Non-Retirement Account Statements

Life Insurance - Please provide Client and Spouse details: Death Benefit, individual or group, Term Remaining, Cash Value, Premium, Insured, Beneficiary;

Do you own any Disability or Long Term Care Insurance? If so, please provide details:

Please go to www.peakwm.com/expenses and download the expense tracking spreadsheet template and enter in your monthly/seasonal expenses and provide us with a total estimate of your current cost of living. Please enter the total cost of living in the box below:

Save & Return

Use an account to return to saved work.

What is your biggest obstacle in reaching your financial goals? *

What is your goal for our meeting? *

Are you working with another advisor presently? If so, why are you looking to make a change?

Short Term, Intermediate Term, and Long Term Goals? *