Please take a moment to complete this brief Quote Request form. All information will remain confidential. Your request will be reviewed and we will respond within two business days
 
Specializing In Tax-Strategy Planning     
ESTATE PLANNING QUESTIONAIRE - Page One
Agent Name:  
 
Agent Phone Number:  
 
Agent Fax Number:  
 
Agent E-Mail Address:  
 
Client's Full Name:  
 
Client's Date of Birth  
 
Tobacco User?  
  Yes No
Client's Primary Residence State:  
 
Is property owned other sates?  
  Yes No
Spouse's Full Name:  
 
Spouse's Date of Birth:  
 
Spouse's Primary Residence State:  
 
Do either party have wills?  
  Yes No - If yes, Date Signed:
Do either party have trusts?  
  Yes No - If yes, Type if known:
   When established:
   List the beneficiaries:  
Are any Buy-Sell Agreements in place?  
  Yes
Are any other contractural agreements in place that may effect estate distribution?  
 
List Estate Assets
Asset Current
Value		 Purchase
Price		 Date
Bought		 Asset Current
Value		 Purchase
Price		 Date
Bought
Stocks
Mutual Funds
Bonds
Tax-Free Bonds
Collectibles
Art
Primary Home
Other Homes
Farm Property
Business Property
Pension Plans
Roth IRAs
Annuities
Other Liquid Assets