Investment Financial Profile

Client Name: Sex: Date of Birth: Age:
Spouse Name: Sex: Date of Birth: Age:
Child's Name: Sex: Date of Birth: Age:
Child's Name: Sex: Date of Birth: Age:
Child's Name: Sex: Date of Birth: Age:
E-mail:            
Mailing Address: City: State: Zip:
Telephone-Home: Other:
Client Employer: Salary:    
Spouse Employer: Salary:        

Retirement Goals

Retirement Age:  
       
Retirement Income: $ / month:
In today's dollars, how much do you want per month? This should be a before tax amount realizing the mortgage will probably be paid off and the children out of the house.
Client Monthly Pension: $ Starts at Age: COLA (Cost of Living Adjustment): Yes No
Spouse Monthly Pension: $ Starts at Age: COLA (Cost of Living Adjustment): Yes No

Assets & Liabilities

Investment Name (If mutual fund, please name) Owner Current Value
$
$
$
$
$
$
$
$
$
Residence Value: $ Mortgage Loan: $ Rate: Home Equity Loan: $
Mortgage Type: Balloon ARM Fixed: 15 or 30 year

Retirement Plans

Please provide a copy of your most recent statement.

Company Retirement Plan & Type
(401(k), IRA, Profit Sharing)
Owner Current Value Previous
Monthly Deposits
$ $
$ $
$ $
$ $
$ $
Do you have:    
Wills: Yes No Trusts: Yes No Are they current? Yes No
 
Please complete this profile and press the submit button to send the document through our secure electronic system.
Or print and fax it to our Investment Dept at 715-258-1414. Thank you.

FSB Investment Services
112 W. Fulton Street, Waupaca, WI 54981
Telephone: 715/258-1400 Fax: 715/258-1414 E-mail: susanm@fsbinvestments.com

Securities and Advisory Services Offered Through Commonwealth Financial Network | Member FINRA, SIPC| Not FDIC insured. No bank guarantee. May lose value.