Contact Form New Client

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Legal Name

First Middle Last

Preferred Name

Social Security Number

Birthdate

Marital Status

Home Phone

Work Phone

Mobile Phone

Personal Email

Work Email

What is your primary email?

We may send you important documents and other communications via email. To ensure prompt delivery, we suggest providing a personal email address. If you choose to provide a work email address, we kindly ask that you notify us immediately if there are any changes in your employment status.

Personal Email

Work Email

Address

No P.O. Boxes

Street Address Address Line 2 City State ZIP Code

Mailing Address

Same as previous

Street Address Address Line 2 City State ZIP Code

Contact Preference

Phone

Mail

Fax

What number should we contact?

Home Phone

Work Phone

Mobile Phone

Do you need to add another address?

Yes

Other Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If you need to

Employment Information

Other

Job Title:

Employer Information

Name of Employer Employer Address City and State Zip/Postal Code Website Country

Citizenship

US Citizen

Non-US Citizen

Birth State

Type of Citizenship

Country of Citizenship:

Driver's License State

Driver's License Number

Expiration Date

Government ID State

If your government issued ID is a DL, you will not need to enter the information twice.

Government ID Number

Government ID Expiration

Approximate Net Worth

Annual Income $

Annual Bonus $

Pension $

Social Security $

Annuity $

Additional Person

This section is available if you need to provide contact information for another individual. Dependent information is asked for in a later section of this form.

Do you need to add another person?

Yes

Legal Name

First MI Last

Preferred Name

Social Security Number

Birthdate

Marital Status

Home Phone

Work Phone

Mobile Phone

Work Email

What is your primary email?

Personal Email

Work Email

Address

No P.O. Boxes

Same as previous person

Street Address Address Line 2 City State ZIP Code

Mailing Address

Same as previous person

Street Address City State ZIP Code

Contact Preference

Phone

Mail

Fax

What number should we contact?

Home Phone

Work Phone

Mobile Phone

Employment Information

Other

Job Title:

Employer Information

Name of Employer Employer Address City and State ZIP/ Postal Code Website Country

Citizenship For Second Person

US Citizen

Non-US Citizen

Birth State

Type of Citizenship

Country of Citizenship:

Driver's License State

Driver's License Number

Expiration Date

Government ID State

If your government issued ID is a DL, you will not need to enter the information twice.

Government ID Number

Government ID Expiration

Approximate Net Worth

Annual Income $

Pension $

Bonus $

Annuity $

Social Security $

Combined Household Income $

Source of Account Funding

This section is applicable to any new client planning to open accounts. Please select multiple sources, if you are opening more than one account. What best describes the ongoing of funding the account you will be opening?

What best describes the ongoing of funding the account you will be opening?

Beneficiary Information

If you would like to provide additional contact information for beneficiaries, or would like to add a trust, you can provide us with that information at a later date.

Would you like to enter beneficiary information at this time?

Yes

I would like to add a trust as my beneficiary; please have Melinda contact me for the information.

Yes

Legal Name

First MI Last

Social Security Number

Birthdate

Type of Beneficiary

Primary

Contingent

Phone

Relationship

What is your relationship to your beneficiary?

Percentage

What percentage of your benefit would you like this beneficiary to receive?

Legal Name

First MI Last

Social Security Number

Birthdate

Type of Beneficiary

Primary

Contingent

Phone

Relationship

What is your relationship to your beneficiary?

Percentage

What percentage of your benefit would you like this beneficiary to receive?

Legal Name

First MI Last

Social Security Number

Birthdate

Type of Beneficiary

Primary

Contingent

Phone

Relationship

What is your relationship to your beneficiary?

Percentage

What percentage of your benefit would you like this beneficiary to receive?

Dependent Information

Do you have dependents?

Yes

Legal Name

First MI Last

Preferred Name

Social Security Number

Birthdate

Legal Name

First MI Last

Preferred Name

Social Security Number

Birthdate

Legal Name

First MI Last

Preferred Name

Social Security Number

Birthdate

Legal Name

First MI Last

Preferred Name

Social Security Number

Birthdate

Financial Contacts

To provide you with the best financial planning services, we require a complete overview of your financial life. As such, we ask you to provide us with the necessary contact information of your financial professionals. Please note that this section is for record-keeping purposes only and does not authorize us to contact or share information with these professionals without obtaining your written consent.

Do you want to add an estate planning attorney?

Yes

Do you need a referral lists of estate planning attorneys?

Yes

Name

Business Name Contact First Name Contact Last Name

Primary Telephone Number

Do you want to add an accountant/CPA?

Yes

Do you need a referral list of accountants/CPAs?

Yes

Name

Business Name Contact First Name Contact Last Name

Primary Telephone Number

Trusted Contact

When managing your finances, it's crucial to have a support system in place. One way to ensure this is by designating a trusted contact person who can step in and help you in an emergency or if you cannot make financial decisions on your own. Trusted contact could be a family member, friend, or other individual whom you feel comfortable confiding in. However, it is important to note that your trusted contact cannot be your financial advisor.

Do you want to add a trusted contact?

Yes

Legal Name

First MI Last

Relationship

Primary Telephone Number

Mailing Address

Street Address City State / Province / Region ZIP / Postal Code

Power Of Attorney Supplement

Do you have a power of attorney in force?

If you have a power of attorney in force, please answer YES to share the information for the individual possessing power of attorney. This form should not be used to appoint or supplement an advisor or advisor representative as power of attorney but is to notify us of relevant contact information.

Yes

Legal Name

First Name MI Last Name

Social Security Number

Birthdate

Home Phone

Work Phone

Mobile Phone

Address

No P.O. Boxes

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mailing Address

Same as previous

Street Address City State / Province / Region ZIP / Postal Code

Contact Preference

Phone

Mail

Fax

What number should we contact?

Home Phone

Work Phone

Mobile Phone

Employment Status

Employed

Self-Employed

Unemployed

Retired

Homemaker

Student

Employer Name

Type of Business

Occupation

Employer Street Address

Street Address City State / Province / Region ZIP / Postal Code

Occupation Code

Type of Business code

Occupation Box

Citizenship

US Citizen

Non-US Citizen

Type of Citizenship

CAPTCHA

Disclaimer

Advisory services offered through Capital Asset Advisory Services, LLC, a Registered Investment Advisor. This site is published for residents of the United States only. Representatives may only conduct business with residents of the states and jurisdictions in which they are properly registered. Therefore, a response to a request for information may be delayed until appropriate registration is obtained or exemption from registration.

Additional Person

Source of Account Funding

Beneficiary Information

Dependent Information

Financial Contacts

Trusted Contact

Power Of Attorney Supplement

Contact Info

Compliance

Disclaimer