Survey page

First Name *

Last Name *

Email *

Phone *

American Citizen or Resident? *

Yes

Congratulations on deciding to get your customized presentation to take your finances and life to the next level and fast track reaching your objectives!

Your future self and loved ones will be grateful you did!

Your customized presentation will be conducted based on completing a brief questionnaire about your current financial situation and where we can best support you to reach your most meaningful objectives. If you do not know answers, please make your best educated guess.

Age *

Sex *

Male

Female

Marital Status *

Number of kids *

Spouse First Name

Spouse Last Name

Spouse Email

Spouse Age

Spouse Sex

Male

Female

What is your employment status? *

Employed

Self-employed

What is your current take home household pay (after tax)? *

What are your current debt amounts for the following and approximate monthly payments?

Mortgage Balance *

Mortgage Payment *

Credit Card Payment *

Credit Card Balance *

Student Loan Balance *

Student Loan Payment *

Personal Loan Balance *

Personal Loan Payment *

What is the approximate amount of the following types of assets you own?

Checking and savings *

Brokerage account/Individual account mutual funds *

Retirement Accounts (401k, 401a, 403b, IRA, Roth IRA) *

Home Value *

Real Estate *

Cash Value Insurance *

Other *

What are your specific financial objectives (write in, check off applicable, or both)

Write your objectives *

Check off applicable *

To live an abundant life where I live a purpose and do what I want without feeling scarce about money.

To travel/go on vacations I want

Invest into myself and development

To buy a home

To retire

To have plenty of options and be able to afford what I want and need

To protect my family and have financial security

To buy a car or other major purchases

Save for a wedding

Save for future education or child’s education

To learn how to start a business

Given money can be an impactful tool and you can learn effective strategies, what do you aspire it to help you be in your life? (write in, check off applicable, or both)

Write your objectives spouse *

Check off applicable for spouse *

To be the best spouse I can be

To be the best parent I can be

To contribute to a cause meaningful or beyond myself

To be knowledgeable about money so I can help people I care about and beyond

How would you rate your risk tolerance when it comes to money *

Conservative

Moderate

Aggressive. I am high risk, high reward. I am willing to lose a substantial amount if it means I can make a fortune.

Which BEST describes your energy level around the subject of money? *

Low. I feel like shutting own when the subject comes up.

Neutral. I don’t really have much thought about it as long as I am comfortable.

Energized. Generally, I want to know more about opportunities and make things happen financially.

Highly Energized. Generally, I see money in a way that serves much more than myself and am motivated for brining abundance to much more than myself.

Which BEST describes your energy level around the subject of money? *

Low. I feel like shutting own when the subject comes up.

Neutral. I don’t really have much thought about it as long as I am comfortable.

Energized. Generally, I want to know more about opportunities and make things happen financially.

Highly Energized. Generally, I see money in a way that serves much more than myself and am motivated for brining abundance to much more than myself.

What are the biggest external challenges you or you and your spouse face when it comes to money? (check all that apply) *

Living expenses are way too high/inflation

Taxes are too high

Debts cost too much or balance is too high

Income is lower than desired

Do not have much help with my finances

Do not have enough money available (it is lacking or tied up in things like real estate and retirement accounts)

Have challenges sustainably growing and protecting my finances

Want to make a big purchase but interest rates are too high too get a loan or poor credit

Other

Specify external money challenges *

What are the biggest internal challenges you or you and your spouse face when it comes to money? (check all that apply) *

Have challenges to know how to save and invest money each month

Similar patterns of negative financial behaviors passed down by family members

Lack financial literacy to make effective financial decisions

Have impulse buying or spend more than I know I should (or spouse)

Feel overwhelmed with what to do

Feel stressed that it seems we should be doing much better

Feel stressed that life seems to put us in difficult financial situations

Lack of self-discipline, procrastination, or motivation with money

Confidence that I can do well or that I deserve to do well financially

What philosophical challenges do you or your spouse have about money? (check all that apply) *

It seems like most financial companies are in it for themselves and really do not care about clients.

The financial industry seems manipulated to keep the general population on an economic timeline that only serves the wealthy.

Our current political climate does not seem to support the general populations economic health or seemingly care to.

There seems to be an avoidance to truly education the mass population around money as it is not often taught in schools or at jobs.

Consumerism is teaching people to spend money for superficial reasons

Most financial professionals while meaning well, are simply trained sales people to serve large institutions first

The government takes too much of heard earned money from families in income and estate taxes

Middle and lower income seems to be conditioned through school systems, the use of media, and political narratives.

Other

Specify philosophical money challenges *

What do you MOST believe is the reason only 4% of families are financially fit and 1% are wealthy by the age of 65 according to the US Census Bureau? *

The lack of financial literacy for the general masses

The financial system is generally constructed to serve the wealthy and large institutions

Most people are conditioned to serve the system to create wealth for others and not themselves

The cost of living is too high

Which of these BEST describes your financial story as you see it: *

You feel like you are struggling compared to where you want to be.

You feel stuck where you are. You get ahead at times and behind at times but do not feel like you are getting ahead like you want.

You feel like you are in a pretty good position but comfort and doing the same things seem to hold you back from making better progress.

You feel like you are where you want to be yet you know there is always more and want more for yourself and others.

What people help you with your finances currently (check all that apply): *

Certified Public Accountant

Financial Advisor/Stock broker

Life Insurance Agent

Friend or family (non-professional)

Authors or influencers

I do everything myself

I have no help and do not do much myself either

Other

Specify who helps with your finances *

What do you wish you had more support with or way about getting help financially? (check all that apply) *

More education. It seems overly product oriented and seems like more knowledge should be obtained more to grow in the process.

More collaboration. It seems too passive where someone else is supposed to be the hero and input is limited. The ability to earn an income and do more outside of meetings seems neglected or undervalued.

More execution. Results is what it is about.

More value. Need more access to other ways to reach objectives.

Other

What are your desires when it comes to planning your finances? (check all that apply) *

Having alternative options from what traditional planning teaches

The ability to show solutions for more abilities not only in the future, today too

Showing value beyond just a product

Having a guide to help execute the plan

Options that align to core values

A plan that involves collaboration and winning together

Specify where you need more financial support *

Which of the following would you consider when it comes to income? (check all that apply) *

A side hustle

Starting a new business

A career change

Better ways to earn residual income

What opportunities that you potentially are missing out on, most excite you to learn about? (check all that apply) *

Ways to reduce debt payments, taxes, and living expenses

Potential ways to earn a higher income

Tax fee growth

Safe ways to grow wealth

Creative financing strategies

Ways to use other people’s money like the wealthy do

Creating a legacy for my family

Transitioning from an employee or self-employed to an investor or business owner

Other

Specify missed opportunities you’re excited to learn about *

If you do not act to take your finances to the next level, what do you expect will happen? (check all that apply) *

Nothing, everything will stay the same

Might get a little behind but not too worried about it

Will be letting myself down and those that I care about

Money is vital and opportunities will be missed to experience much more in life

Stress and overwhelm will be present

People will see me as irresponsible and not trust me

What value would you most like to see in meeting with a Wealth Systems Consultant? (check all that apply) *

Someone who cares and that has my interest first and can help me with appropriate solutions

Winning together in a collaborative dynamic

Having ah-ha moments

Reaching my financial objectives at an accelerated rate

Someone who makes me feel confident about my financial decisions

Someone who is laser focused on my objectives and speaks direct