In order to personalize our service to our clients, we like to get to know them from the very beginning! Please take a moment and tell us a little about yourself. Our goal is to provide the highest level of service possible to our clients so they will continue to refer us to their friends and family.
Name:
Present Address:
Construction or Purchase Address:
Home Phone: Fax:
Work Phone: Fax:
Spouse/SO Work Phone: Fax:
Cell Phone: Spouse/SO Cell Phone:
E-Mail: Spouse/SO E-Mail:
Employer: Spouse/SO Employer:
Your Birthday: ____/____/____ Spouse’s: ____/____/____ Wedding Anniv: ____/____/____
Please list the names and birthdates of any children living with you:
Pets:
Where are you from originally? Spouse/SO?
Please list your favorite in the following categories:
Type of Food? Spouse/SO?
Restaurant? Spouse/SO?
Sport, Hobby? Spouse/SO?
(over please)
Concierge Form (cont.)
· Do you expect your income to be changing at any time in the next three to five years?
· How long do you plan to live in this house?
· What is most important to you about your overall financial planning strategy at this time?
· When we communicate with you going forward, what is your preferred form of communication? Is it e-mail, telephone or mail? Please verify your current e-mail address.
· Do you foresee incurring other financial obligations within the next 5 years, such as a new car, new baby, college expenses, change in work time, etc., or have you done any of these since obtaining financing with our team?
· If we can help show you some ways of building wealth faster or becoming debt-free quicker, would you be interested?
· On a scale of 1-10 (10 being best) please rate your relationship with the following situations:
______Real Estate Agent
______Tax Preparer/CPA
______Financial Planning
______Trust and/or Will
______Life Insurance
______Auto and Home Insurance
We ask you these questions because we want to make sure you are aligned with the right people who can be an enhancement to your overall financial picture. David Kuiper has been fortunate enough along with Lori Topp and Joni VanRhee to make acquaintance with many people who are outstanding in other areas of financial services and we want to make sure that if you have a need in those areas, we are assisting you in filling that need.
· Do you currently have a Retirement Plan established?
· How old do you want to be when you retire?
· Do you currently have a Tax-free college fund set up for your children or your grandchildren?
· Who do you know that might benefit from our services?