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Financial Concerns Worksheet

Please fill out the form below to the full extent of your abilities. The more information we obtain from you, the more we will be able to help going forward!

Full Name

Preferred Contact Method

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Retirement:

1. At what age do you want to retire?

2. Will you have enough money to be able to retire when you factor in inflation and rising costs? 

3. What kind of retirement do you envision having? 

Pre-mature Death:

1. Will your family be able to maintain the same standard of living? 

2. Do you have a will or a trust in place?

Long Term Illness:

1. How will you pay the bills? Do you have an emergency fund? 

Disability:

1. Who will take care of you or the people you take care of now?  

Key employee or Stockholder Death:

1. How will you fill the void (liquidation, consolidation, increased debt load)? 

Financial Advisory Team:

1. How happy are you with your accountant, attorney, insurance agent, realtor, etc.? 

Macro-Economic/Political Direction:

1. Inflation

2. Taxes

3. Future Income

4. Healthcare

5. Environment/Pollution

6. Public Morals

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