Personal Financial Viewpoint

Personal Financial Viewpoint

Please fill out as much of the form as you are willing to. The more information you supply, the better we will be able to provide you with appropriate assistance.

Your privacy is very important to us. All of your information is kept in the strictest confidence, and will not be shared with any individuals or organizations other than those affiliated with American Consumer Wealth Services and Hart Financial.

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Personal Data
* Please provide at least one phone number
My/Our Family Includes:
No children yet
Children under 18
Children 18 or over
Plans for additional children
No plans for children
My Annual Income Is:
more than $100,000
$75,000 to $100,000
$50,000 to $75,000
$25,000 to $50,000
less than $25,000
I/We Own:
A home
Pleasure property
Revenue property
A farm
A business
My/Our Assets Are Worth:
more than $500,000
$250,000 to $500,000
$100,000 to $250,000
$50,000 to $100,000
less than $50,000
I Am An/My Spouse Is An:
Employee
Executive/Manager
Owner/Partner
Other
Our Other Family Income Is:
more than $100,000
$75,000 to $100,000
$50,000 to $75,000
$25,000 to $50,000
less than $25,000
I/We Have:
Savings and certificates
Stocks and/or bonds
Mutual funds
Tax deferred plans
Life insurance cash values
My/Our Liabilities Are:
more than $500,000
$250,000 to $500,000
$100,000 to $250,000
$50,000 to $100,000
less than $50,000
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Please Check The Boxes That Reflect Your Personal Views.
A - Essential   B - Fairly Important   C - Of Little Value   D - Not Applicable
My Views:
A   B   C   D 
1. Assistance from qualified advisors in planning our estate and financial requirements is...
2. Saving and accumulating money regularly is...
3. When I die, for my family to be able to maintain its current standard of living is...
4. A competent financial advisor who is knowledgeable on products and their proper usage is...
5. Long-term retirement ineome planning is...
6. Help from my Current financial advisor has been...
7. Investments that offer high growth potential are...
8. Investments in the stock market or mutual funds are...
9. In my investments, a low risk factor is...
10. A complete understanding ofour financial situation is...
Please Check The Boxes That Reflect Your Present Situation.
Y - Yes   N - No   ? - Not Sure   X - Not Applicable
Estate Planning:
Y   N   ?   X 
1. We are well informed about estate planning.
2. My spouse has a full understanding of our estate.
3. We have appointed a guardian for our minor children.
4. We understand how taxes will be applied to our estates.
5. We know what income our family will receive from the net proceeds of our estate.
6. We require assistance in organizing our estate plans.
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Please Check The Boxes That Reflect Your Present Situation.
Y - Yes   N - No   ? - Not Sure   X - Not Applicable
Economic Development:
Y   N   ?   X 
1. We know what we want to accomplish financially.
2. My spouse clearly understands our financial situation.
3. We are good at managing our income/expense flow.
4. We systematically save and accumulate money for investment opportunities.
5. Our employers provide adequate pension plans.
6. We maximize our tax deferral contributions each year.
7. We require assistance in organizing our financial affairs.
8. If I or my spouse should ever become disabled, a replacement income is important.
9. Long-term health care is important.
10. We require assistance in reviewing our disability income program and/or long-term care.
Insurance Planning
1. Personal Life Insurance
Spouse
Self
$1,000,000 or more
$500,000 to $1,000,000
$250,000 to $500,000
$100,000 to $250,000
Less than $100,000
2. Type of Personal Life Insurance
Spouse
Self
Term Insurance
Cash Value accumulation
Association, bank or mortgage insurance
Group Insurance (work)
Not sure
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Changes
In the next year I plan to:
Graduate
Marry
Buy a home
Have a child
Change employment
Receive a promotion
Start a business
Receive an inheritance
Borrow money
Repair credit
Pay off a loan
Save more money
Start a financial plan
Invest more money
Purchase a property
Sell property
Sell a business
Retire
Refinance
Other Plans

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Discussion Priorities
Short-Term Needs
Personal Life Insurance
Insurance for my spouse
Health insurance review
Auto, Home, Liability policy review
Review of existing coverage
Mortgage disability protection
Disability income protection
Spousal disability protection
Retirement savings
Insurance for my children
Education plans for my children
Roth IRA's
401(k) review
Inflation/Standard of living update
Budgeting
Paycheck planning
Mortgage review
Credit repair
Mortgage life insurance
Long-Term care coverage


Long-Term Needs

Savings and accumulation
Buliding personal wealth
Planning for retirement
Investment priority planning
Estate planning
Business insurance planning
Other Issues

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