Client Personal Profile Step 1 of 7 14% First Name* Last Name* Client Preferred Name (Nickname) Home Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code Birthdate* MM slash DD slash YYYY Home PhoneCell PhoneWork PhonePreferred Phone*CellHomeWorkPersonal Email Work Email Preferred Email*PersonalWork Occupation / Job Title Employer Name Employer Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Marital Status*DivorcedDomestic PartnerMarriedSeparatedSingleWidowedHiddenClient has spouse/partner Spouse/Partner Spouse/Partner First Name Spouse/Partner Last Name Spouse/Partner Birthday* MM slash DD slash YYYY Home PhoneCell PhoneWork PhonePreferred Phone*HomeCellWorkPersonal Email* Work Email Preferred Email for Spouse/Partner*Personal EmailWork EmailOccupation / Job Title Employer Name Employer Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Attorney Name CPA Name Approximate Total Net Worth (All assets minus liabilities)*<$50,000Between $50,000 - $100,000Between $100,000 - $250,000Between $500,000 - $1,000,000Between $1,000,000 - $2,000,000Over $2,000,000Approximate Total Liquid Net Worth (Cash plus investments readily convertible to cash - do not include retirement accounts if under 59 1/2)*Household Annual Income*Please indicate your investment experience Extensive Good Limited None Do you have children/grandchildren/dependents?* Yes No Name Date of Birth MM slash DD slash YYYY Relationship Dependent? Y/N Name Date of Birth MM slash DD slash YYYY Relationship Dependent? Y/N Name Date of Birth MM slash DD slash YYYY Relationship Dependent? Y/N Name Date of Birth MM slash DD slash YYYY Relationship Dependent? Y/N Name Date of Birth MM slash DD slash YYYY Relationship Dependent? Y/N Name Date of Birth MM slash DD slash YYYY Relationship Dependent? Y/N Which Legacy advisor is your primary contact? David Dwyer Jeff Hrabe Joe Nafziger Chris Proctor Andrew Rogers Jacob Watts Mike Wren My preferred day for review meetings/phone calls is:* Tuesdays Wednesdays Thursdays My preferred time of day for meetings/phone call is:* Before 10 10-2 2-4 After 4 Anytime My hobbies include: Art Bicycling Boats Camping Cars Cigars Culinary Exercise Game Night Gardening Golf Grandkids Guitar Music Outdoors (Fishing, Hiking, Hunting) Quilting Reading Running Sports Travel Volunteering Whiskey Wine Woodworking Yoga Additional Hobbies? CAPTCHADate MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
