Prime Corporate Services (Tax Specialists)

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* 1. Name:

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* 2. Email Address:

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* 3. Phone Number:

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* 4. Are your brokerage accounts funded with a retirement account (IRA), Taxable Account (Cash) or both?

IRA

Cash

Both

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* 5. Have you been affected by Capital Gains tax in the last 2 years?

Yes

No

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* 6. Do you have a Trust, Will, Living Will, or Power of Attorney in place?

Yes, I have a Trust

Yes, I have a Will

Yes, I have a Power of Attorney

No

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* 7. When was your Trust, Will, or Living Will last updated?

Date / Time

Date