Confidential Financial Form

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Financial Advisors of America Inc.

CONFIDENTIAL PERSONAL PROFILE

Please fill this form completely. The more information I have, the better I will be able to help you. Rest assured this is completely CONFIDENTIAL.

First Name Last Name Email Address Phone (cell preferred) Occupation / Job Title

Gender

Male Female

Age

Married?

Yes No

Spouse Information

Spouse Full Name

Spouse Age

Spouse Occupation / Job Title

Spouse Income ($)

Are you a homeowner?

Yes No

Your Property / Equity Snapshot

Year you purchased your home?

Purchase Price ($)

Current Mortgage Balance ($)

Current Selling Price ($)

Approximate EQUITY ($)

Do you currently have any savings or retirement accounts?

Yes No

Savings & Retirement Snapshot

IRA

Yes No

401(k)

Yes No

Savings

Yes No

Where / Describe (bank, etc.)

Investments

Yes No

Where / Describe (funds, brokerage, etc.)

Total Approx Balance ($)

Any old 401(k) / IRA you may want to move?

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