Introductory Survey

The Strebel Planning Group looks forward to welcoming you to our office.

We truly appreciate the opportunity to meet and spend some time with you.

The introductory meeting is exploratory in nature. You will not be charged nor will you be obligated to work with us.
Please take a couple of minutes to complete this form.

All information you share with us will be held in the strictest confidence.

Thank you!
The Strebel Planning Group Team

Today's Date:
* Full Name:
Date of Birth:
Age:
Nickname:
* Email Address:
Occupation:
Annual Income: $
Employer:
Work Phone:

Interests:

Partner's Full Name:
Date of Birth:
Age:
Nickname:
Email Address:
Occupation:
Annual Income: $
Employer:
Work Phone:

Interests:

Address:
City:
State:
Zip:
Home Phone:
Home Fax:
Preferred Phone Number:

Marital Status:
Wedding Anniversary Date:

Child's Name:
Date of Birth:
Age:

Child's Name:
Date of Birth:
Age:

Child's Name:
Date of Birth:
Age:

Preferred Written Communication Channel
How did you hear about us?
Other:

You were referred to us by:

Do you currently work with a Certified Public Accountant?	Yes No
Have you worked with an accountant in the past?	Yes No
Do you presently prepare your own tax returns?	Yes No
Do you currently work with a Certified Financial Planner?	Yes No
Have you worked with a financial advisor in the past?	Yes No
Do you presently do your own financial planning?	Yes No
Are you a business owner?	Yes No

The focus of this meeting is
Investible assets (includes savings, stocks, bonds, retirement assests):
What was your motivation for contacting our firm?

What specifically do you want to be sure we discuss during this meeting?

Are You Human?

* 5-2+1 =