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

Please provide your:

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* 1. Please provide your:

Is your company a:

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* 2. Is your company a:

Please provide Owner Names, Percentage, and Relationship

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

Company Real Estate: Do you

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* 4. Company Real Estate: Do you

With regards to your business property:

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* 5. With regards to your business property:

Gross Revenues (estimate)

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* 6. Gross Revenues (estimate)

Pre-Tax Profits (estimate)

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* 7. Pre-Tax Profits (estimate)

Owner Compensation (current full year)

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* 8. Owner Compensation (current full year)

Most Recent Business Valuation (leave blank if none)

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

Business Active Children, Ages and Titles

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* 10. Business Active Children, Ages and Titles

Children who are Not Actively Working in the Business, Ages

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

Number of

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* 12. Number of

Names, Ages, Titles of "Key" Employees

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

Do you have Employment Agreements with your "Key" Employees?

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

Which Benefit Plans Do You Offer

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* 15. Which Benefit Plans Do You Offer

In order of preference, would you prefer to

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

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

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

Do you have

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* 18. Do you have

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

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

Please rank your planning priorities

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* 20. Please rank your planning priorities

What did we not cover that is important to you?

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

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

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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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