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Snapshot Customer Questionnaire
Snapshot Customer QuestionnairePlease fill in data and answer the questions below to the best of your ability. At the end, we'll export a file you can send to your advisor.
You can also import an existing questionnaire data file, to pick up where you left off.
Family
Starting with yourself, enter your family's information below. If you need to add or remove slots, use the 'Add' and 'Remove' buttons below.
| First Name | Middle Name | Last Name | Gender | Date of Birth | |
|---|---|---|---|---|---|
Income
Employment
Are you employed or self-employed? List any income from the following sources: W2 Employee, Self-Employed W2, Self-Employed 1099, Social Security.
| Family Member | Employment Name | Income Type | Annual Wage/Salary | Notes | |
|---|---|---|---|---|---|
Businesses
Do you own any businesses?
| Owner | Business Name | Business Type | Business Nature | Net Profit | Market Value | Percent Owned | |
|---|---|---|---|---|---|---|---|
Savings
Liquid Savings
Do you have any bank or credit union accounts, or other forms of liquidity?
| Owner | Name | Type | Balance | Joint Owned | |
|---|---|---|---|---|---|
Business Liquid Savings
Do any of your businesses have bank accounts, or other forms of liquidity?
| Owning Business | Name | Type | Balance | ||
|---|---|---|---|---|---|
Investments
Paper Investments
Do you own any paper investments that are not held inside an IRA or Qualified Plan? Examples: Stocks, Bonds, Mutual Funds, Annuities, REITs.
| Type | Name/Financial Institution | Tax/Investment Basis | Shares Owned | Current Value | Annual Income/Dividends | |
|---|---|---|---|---|---|---|
Real Estate Investments
Do you own any real estate investments? Examples: Rental Property, Land Lease, Farm or Ranch
| Type | Name/Address | Purchase Date | Original Purchase Price | Current Market Value | Gross Income | Net Income | % Ownership | Other Owners | |
|---|---|---|---|---|---|---|---|---|---|
Education Savings Plans
Do you own any Education Savings Plans (529 Plan or Coverdell Education Savings)?
| Type | Name | Current Balance | Annual Contribution | |
|---|---|---|---|---|
Retirement Accounts
Do you have any retirement accounts, such as 401(k)’s, IRA’s, or other qualified retirement plans?
| Owner | Name | Type | Current Balance | Contribution (Yr) | Employer Match / Other Note | |
|---|---|---|---|---|---|---|
Assets
Precious Metals or Stones
Do you own any precious metals, or other items? Examples: Gold, silver, jewels.
| Type | Weight (oz.) | Current Value | Purchase Price | |
|---|---|---|---|---|
Personal Real Estate
Do you own any personal real estate? Examples: Primary or secondary residence, raw land.
| Type | Location/Address | Current Value | Purchase Price | Purchase Year | |
|---|---|---|---|---|---|
Personal Debt
Do you have any personal debt? Examples: Mortgage, loans, auto payments.
| Loan / Lender Name | Debt Type | Original Balance | Current Balance | Monthly Payment | Interest Rate | Months Remaining | |
|---|---|---|---|---|---|---|---|
Business Debt
Do you have any business debt? Examples: Business loans, equipment loans.
| Business | Loan / Lender Name | Debt Type | Original Balance | Current Balance | Monthly Payment | Interest Rate | Months Remaining | |
|---|---|---|---|---|---|---|---|---|
Finish
We are ready to export your data into a file you can send to your advisor. Don't worry if some details are still missing; your advisor can work with you to fill in the rest later. You can also reload the data we export here at a later time, and resume.