Name *

First Name

Last Name

Phone

(###)

###

####

Marital Status *

Single

Married

Divorced

Widowed

Do you have children? *

Yes

No

Do you have grandchildren or other people (not your children) you want to leave something to? *

Yes

No

Is there anyone you specifically do not want to leave anything to? *

Yes

No

Not sure yet

What types of assets do you currently own? *

(Check all that apply)

A home or other real estate

Bank accounts

Retirement accounts (401k, IRA, etc.)

Investment/brokerage accounts

Life insurance or annuities

A business or LLC

None of the above

Roughly, what do you estimate the total value of everything you own to be (real estate, accounts, etc.)? *

Under $500,000

$500,000 – $1M

$1M – $2.5M

Over $2.5M

Do you want help making sure your assets are properly titled into a trust after it’s created? *

Yes

No

Not sure yet

How do you want your assets to be passed down after your death? *

Directly to my heirs, no strings attached

I’d like someone to manage the inheritance for a period of time

Not sure yet – need guidance

Do any of your heirs have special needs or receive government benefits? *

Yes

No

Do you want to include gifts to a church, school, nonprofit, or charity in your plan? *

Yes

No