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First Name

Last Name

Date of birth

Phone

Postal code

If married, please include spouses Name & Date of birth

Household Gross Income

Household Net Income

Total Personal & Business Liquid Cash (Cash, Checking & Savings Money Market, Mattress etc)

Total other investments & values you have in place (Brokerage accounts, Traditional retirement accounts, Private Equity, Crypto, Commodities, etc)

Please list any type of real estate you own

What do you like about your current wealth strategy?

What do you dislike about your current wealth strategy?

What are your financial goals?

What is your timeline to complete these goals?

Have you read Becoming Your Own Banker by Nelson Nash?

What is your level of understanding in regards to Infinite Banking Concept ?