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First Name*
Email Address*
Phone Number*
By submitting your personal information, you consent to be contacted by a financial professional regarding your financial strategy for retirement.

We are looking forward to getting together with you. If you have any questions or require special assistance prior to your visit, please call our office at 847.741.2284. *Please note that the form will not save if you leave this website.*

Step 1 of 8

12%

The following items would be helpful to have at the time of our visit:
1. Most Recent Investment Statements
2. Social Security Statements or Estimates (can be found at www.ssa.gov)
3. Most Recent Tax Return
4. Life Insurance and/or Annuity Statements
5. Pension Information, if applicable
6. Legal Documents - Will, Trust, & Powers of Attorney if you would like them reviewed by our attorney
CONTACT INFORMATION
Name
First Last
Nickname
Date of Birth
MM slash DD slash YYYY
Working At/Retired From:
Current/Former Occupation:
Retired?
Spouse Name
First Last
Spouse Nickname
Spouse Date of Birth
MM slash DD slash YYYY
Spouse Working At/Retired From:
Spouse Current/Former Occupation:
Spouse Retired?
Cell Phone:
Spouse Cell Phone
Email Address:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Were you referred to us?
If so, by whom?

FAMILY
Number of Children
Number of Grandchildren
Do any of your children or grandchildren have special needs?
Are any of your children or grandchildren listed as joint owners on any of your accounts/assets?
Family Notes:

LEGAL ITEMS
Which of the following legal documents do you have in place?
Will
Power of Attorney (POA) Assets
Power of Attorney (POA) Health
Living Will
Living Trust
LEGAL ITEMS
Which of the following do you have in place?
Umbrella Policy
Long Term Care Insurance
Death Benefit Life Insurance
Life Insurance

CASH FLOW
Please list monthly income from each source.
Pension
You
Your Spouse
(Survivor Options)
You
Your Spouse
Social Security
You
Your Spouse
Wages
You
Your Spouse
Other Income
You
Source(s)
Total
Other Income
Spouse
Source(s)
Total
Are these amounts net or gross?
How much are your monthly expenses?
Here are some common expenses:
Mortgage, Food, Gas, Car Loan, Insurance, Utilities, Gifts/Donations, Medical, Taxes, Social Security, etc
Total
CASH FLOW
Is your current cash flow sufficient and comfortable?
Do you live off interest your investment dollars earn?
Do you anticipate any significant changes in cash flow?
Are you planning any major lifestyle changes?
Do you foresee any large purchases greater than $5,000 within the next 3 years?
Do you contribute to charity?

LIFE EVENTS
In the near future I expect to: (Please check all that apply)
- Buy a home
- Sell a home
- Improve a home
- Retire
- Care for a parent
- Start/Expand a business
- Pay off debt
- Start a part-time job
- Help fund education costs for a family member
- Sell a property
- Receive an inheritance
- Purchase a property
- Other
ASSETS
Please check off the accounts you currently hold and list the total amount in the box provided, and bring the latest statement in for your visit (Optional).
- Checking, Savings, and CDs
$
- Retirement Accounts (401k, IRA, Roth IRA, etc.)
$
- Brokerage Accounts
$
- Other Assets
$

ASSETS
Property:
Home Value $
Autos and Personal Property $
Rental/Additional Properties $
ASSETS
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY

Additional Information
If you are not already retired, when do you want to retire?
How did you acquire your wealth?
How involved would you like to be with your investments?
What is most important about your money to you?
Are you more concerned about growing your assets or protecting what you already have?
Concerns
Which of the following are your top three concerns?
- Losing too much money in the stock market
- Avoid paying too much in taxes
- Considering retirement and not sure if I/we can afford to
- Not having a reliable income plan for retirement
- Concerned about giving away life savings due to a catastrophic illness
- Outliving nest egg
- Uncertainty about stock market
- Leaving a legacy to children and/or grandchildren
- Need direction with 401K and/or IRA accounts

Objectives
Which of the following describes your risk tolerance when it comes to retirement assets?
What are your Financial Objectives? (Check all that apply)
- Income Now
- Tax-Deferred Growth
- Guarantees Provided
- Pass Assets to Beneficiaries
- Growth Potential
- Other
By submitting your personal information, you consent to be contacted by a financial professional regarding your financial strategy for retirement.
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Helping your family, finances and future starts with a simple conversation. Contact us today to schedule your complimentary call or in-person visit.

847.741.2284

team@guardianwag.com

847.741.2398

81 Market St., Suite 5, Elgin, IL 60123 | Get Directions

81 Market St., Suite 5,
Elgin, IL 60123
Get Directions

847.741.2284

team@guardianwag.com

847.741.2398

Investment advisory products and services made available through AE Wealth Management, LLC (AEWM), a Registered Investment Advisor.

Insurance products are offered through the insurance business Guardian Wealth Advisory Group. Guardian Wealth Advisory Group is also an Investment Advisory practice that offers products and services through AE Wealth Management, LLC (AEWM), a Registered Investment Advisor. AEWM does not offer insurance products. The insurance products offered by Guardian Wealth Advisory Group are not subject to investment Advisor requirements.

Estate planning services are offered through the law firm Sanders Law Firm. Guardian Wealth Advisory Group is an Investment Advisory practice that offers products and services through AE Wealth Management, LLC (AEWM), a Registered Investment Advisor. AEWM does not offer estate planning services. The estate planning services offered by Sanders Law Firm are not subject to investment Advisor requirements. Estate planning services referenced are an outside business activity not offered through or supervised by AEWM. AEWM is not affiliated with Sanders Law Firm. 1948650 - 9/23

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By submitting your personal information, you consent to be contacted by a financial professional regarding your financial strategy for retirement.

Investment advisory products and services made available through AE Wealth Management, LLC (AEWM), a Registered Investment Advisor.

Investing involves risk, including the potential loss of principal. No investment strategy can guarantee a profit or protect against loss in periods of declining values. None of the information contained on this website shall constitute an offer to sell or solicit any offer to buy a security or any insurance product.

Any references to protection benefits or steady and reliable income streams on this website refer only to fixed insurance products. They do not refer, in any way, to securities or investment advisory products. Annuity guarantees are backed by the financial strength and claims-paying ability of the issuing insurance company. Annuities are insurance products that may be subject to fees, surrender charges and holding periods which vary by insurance company. Annuities are not FDIC insured.

Neither the firm nor its agents or representatives may give tax or legal advice. Individuals should consult with a qualified professional for guidance before making any purchasing decisions.

The information and opinions contained in any of the material requested from this website are provided by third parties and have been obtained from sources believed to be reliable, but accuracy and completeness cannot be guaranteed. They are given for informational purposes only and are not a solicitation to buy or sell any of the products mentioned. The information is not intended to be used as the sole basis for financial decisions, nor should it be construed as advice designed to meet the particular needs of an individual’s situation. 1606322 - 12/22

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