Please share a bit about you. This form is confidential, but not secure. Please don’t share account numbers, passwords, or other sensitive information.

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Contact Information

Let’s start with the basics

Please share the best way to reach you.

First Name *

Last Name *

Email *

Phone Number *

Street Address

Address Line 2

City

State

ZIP Code

Your Financial Concerns

Tell us what’s on your mind

These questions help us understand what you’re hoping to find in an advisor.

What is top of mind that’s bringing you to consider financial planning? *

Tax Filing Status *

Interested in investment management? *

Credit card habits *

Other professionals you work with *

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Estate Attorney Accountant / CPA Insurance Agent Investment Advisor None DIY — I manage it myself Other

Your Current Financial Status

A snapshot of your finances

These questions help us understand if we are a good fit for you.

Approximate net worth

Under $500,000 $500,000 to $1M $1M to $5M $5M to $10M $10M or more Other

Account types you’d consider bringing under management

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Brokerage Trust Traditional IRA Active Employee Retirement (401k, 403b) Roth IRA 529 Education Account Donor Advised Fund Other

Retirement timeline

Less than 5 years 5–10 years Over 10 years Currently retired

What Matters to You

Beyond the numbers

Good planning starts with understanding what matters to you, not only the financial details.

What is most important to you?

This might include family, work, community, independence, security, or something else.

How do you enjoy spending your time?

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Location

RHODE ISLAND
& VIRTUAL OFFICES

Contact

(401) 360-4151
Sue@SouthCountyWealth.com

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