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READ IMPORTANT INSTRUCTIONS BEFORE YOU START!

Financial profile for high net worth business owners and affluent families. Do NOT guess or assume any answers to the questions below. Fill in every field. If you do not know the answer, then make sure to add something that won't confuse the issue. (ie: $500,000 and if unsure of $ amount, type $1) Please use whole numbers (i.e. $100,000). Do NOT answer with 100k or any other letters where numbers go.

THIS FINANCIAL PROFILE SHOULD ONLY BE COMPLETED BY THE CBA REFERRING PARTNER.

1. Welcome! Today's date is? *

Send copy of this form to this email. *

CBA's referring partners name? *

Your name if you referred the advisor below.

CBA's referring partner's cell# *

Advisor's full name *

You are the CBA referring advisor. If this is a case you are splitting, then their name goes in the field above.

Taxpayer's information below should only be completed by an approved CBA Partner. Call 704-689-9196 for an approved CBA partner near you.

First Name *
Last Name *

Your client/prospect's name and last name above.

Gender *

FemaleMale

State of Residence *

Business owner? *

Check yes only if you are a full time business owner with significant income.

Is your spouse a business owner? *

What option best describes this taxpayer *

Total net worth? *

Company name *

Occupation *

Type of business or industry *

Number of employees *

Put 0 for none. Do not use text in any field where numbers are required.

What is the approximate value of all businesses that you own? *

What % do you own of this business *

Value of investment property *

Format $0.00 if unknown - do not add text to the above field.

What is the approx. capital gain of your investment property *

Format 0.00 if not known.

Value of real estate holdings? (personal only) *

Format $0.00 if unknown - do not add text to the above field

Birthday

Guess age if no DOB.

Spouse Name *

S. DOB

Is this a client or prospect information? *

Has this client/prospect been introduced to any design? *

If yes, please tell us the short name for the strategy above