Planning Questionnaire

This information will help us to quickly hone in on where you are and what is important to you. It is strictly confidential and will not be shared with anyone but you (and your designated Advisor Team) for your planning. If you have any questions or would prefer a paper form to fill out, please contact Kim White at (866) 370-3774 or by email at Kim@ERSI.biz

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* 1. Please provide your:

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* 2. Is your company a:

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* 3. Please provide Owner Names, Percentage, and Relationship

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* 4. Company Real Estate: Do you

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* 5. With regards to your business property:

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* 6. Gross Revenues (estimate)

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* 7. Pre-Tax Profits (estimate)

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* 8. Owner Compensation (current full year)

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* 9. Most Recent Business Valuation (leave blank if none)

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* 10. Business Active Children, Ages and Titles

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* 11. Children who are Not Actively Working in the Business, Ages

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* 12. Number of

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* 13. Names, Ages, Titles of "Key" Employees

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* 14. Do you have Employment Agreements with your "Key" Employees?

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* 15. Which Benefit Plans Do You Offer

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* 16. In order of preference, would you prefer to

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* 17. Do you have written Business Continuity Instructions and an "Emergency Buyout Plan" in case you were to die suddenly?

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* 18. Do you have

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* 19. Who is on your Advisor Team? (leave Blank if no one)

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* 20. Please rank your planning priorities

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* 21. What did we not cover that is important to you?

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* 22. If we were looking back one year from now at our progress, what would you like to see?

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