DWM New Client Intake

1
Client Name
First Name
Last Name
2
Client Date of Birth
Date
Month
Day
Year
3
Client Primary Phone Number
Area Code
Phone Number
4
Client Primary Email Address
example@example.com
5
Client Current Employer/Job TitleIf you are currenlty retired please indicate that below
6
Spouse name
First Name
Last Name
7
Spouse Date of Birth
Date
Month
Day
Year
8
Spouse Primary Phone Number
Area Code
Phone Number
9
Spouse Primary Email Address
example@example.com
10
Spouse Current Employer/Job TitleIf you are retired, please indicae that below
11
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
12
Wedding Anniversary
Date
Month
Day
Year
13
Do you have children?
YESNO
14
Children's Name
Child 1
Date of Birth
Child 2
Date of Birth
Child 3
Date of Birth
Child 4
Date of Birth
15
How did you hear about us?
Friend
Family Member
I'm an existing Tax Client
Seminar
Mail
Co-Worker
Other
16
Name of who referred you?
17
Do you or your spouse own your own business?
YESNO
18
What type of business is it?
19
Have you or your spouse changes jobs within the past few years?
YESNO
20
Do you have an old retirement account still there?
YESNO
21
What company/financial institution is it held with?Example: Fidelity, Charles Schwab, etc...
22
During the last year did you or your spouse contribute any money to either a 401(K) plan, IRA or any other retirement plan?
YESNO
23
Do you or your spouse own any investment accounts (Stocks, bonds, mutual funds, etc...)
YESNO
24
Where are they held (company)?Investments
25
Do you or your spouse own any annuity or life insurance based products? (Annuities, Life Insurance, Disability Insurance, Long Term Care)
YESNO
26
Where are they held (Company)?Insurance
27
Do you have a current Will or Living Trust?
YESNO
28
Which of the following estate planning documents do you have?
Living/Family Trust
Living Will
Financial Power of Attorney
Medical Power of Attorney
Advanced Directives
Last Will & Testament
29
When was the last time it was reviewed?Approximate date/month or year
30
What is your primary concern(s) that you would like to address at our meeting?
Huge
Large
Normal
Small
Ok
Ok
31
Do you have any pets?
YESNO
32
What are their types and name(s)?Example: Dog-Lab-Molly
33
Do either you or your spouse drink wine, beer and/or mixed drinks?
YESNO
34
What are your favorite drinks?
35
Do either of you drink coffee?
YESNO
36
What is your favorite place and type of coffee?
37
What hobbies do and your spouse enjoy?
38
Do you or your spouse have a favorite author?
YESNO
39
Who are your favorite author(s)?
40
What are you and your spouse's favorite sports teams?
41
What are you and your spouse's favorite restaurant?
Should be Empty: