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.

At the end of the questionnaire, you will be prompted to schedule. Because this is a time invested collaborative opportunity and to ensure it will be a mutually beneficial to win together, please check off the boxes below:

If we show how to find, grow, and protect your money with money with savings we find you (aka money you did not have before), you will collaborate with us on executing strategies to reach your objectives.

You are open minded to learning a new paradigm and alternative strategies traditional planners rarely know about

You acknowledge you are the hero in your story and we are simply your guide. You are open to learning financial literacy and collaborating with a Wealth Systems consultant and service providers to best support you.

If you have a domestic partner or are married, you understand you will each need to complete a questionnaire and be present for the scheduled meeting.

please check off the boxes below: *

You are open minded to learning a new paradigm and alternative strategies traditional planners rarely know about

If you have a domestic partner or are married, you understand you will each need to complete a questionnaire and be present for the scheduled meeting.

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 *

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

Specify external money challenges *

Specify philosophical money challenges *

Specify who helps with your finances *

Specify where you need more financial support *

Specify missed opportunities you’re excited to learn about *