* 1. Please enter your name.

* 2. What is your birthday?

* 3. Please describe your investment goals and objectives for this portfolio in detail.

* 4. What level is your investment knowledge on a scale of 1-10 (1-no knowledge, 10-investment pro)?

* 5. When will withdrawals be needed from this portfolio?

* 6. If you are withdrawing funds from your investments (within the next 3 years) what will be the approximate yearly amount needed or the percentage of the portfolio?

* 7. Do you have any of the following estate documents?

  Yes No Has it been reviewed in the last 2 years? (Yes) Has it been reviewed in the last 2 years? (No)
Will
Durable Power of Attorney
Health Care Surrogate/Living Will
Trust

* 8. Do you have any of the following insurance policies currently?

  Yes No Has it been reviewed in the last 2 years (Yes) Has it been reviewed in the last 2 years (No)
Life Insurance
Disability Insurance
Umbrella Liability Insurance
Identity Theft Insurance

* 9. Please list your sources of income (annual amount)?

* 10. Please list your approximate asset values.

* 11. Please list your approximate liabilities.

* 12. What factors, if any, might impact how this money should be managed (Retiring shortly, recently widowed, currently on disability, etc)?

T