Name *

First Name

Last Name

Name *

First Name

Last Name

Name *

First Name

Last Name

Have you ever owned a home before? *

Yes

No

Do you plan to make additional principal reduction payments in addition to your scheduled monthly mortgage payments? *

Yes

No

Do you foresee incurring other financial obligations within the next 5 years such as: *

A new baby

A new car

Change in work time

College Expense

Of the following financial goals, which would you say is a top priority? *

(Select all that apply)

Improve monthly cash flow

Maximize retirement savings

Building your net worth

Moving to a larger home

Saving money to send kids to college

Maximize investment contributions

Create a 6-12 month cash reserve account

Having your mortgage paid off when you retire

Achieving financial freedom

Create a comprehensive financial plan

Other

Which of the following is most important regarding your mortgage financing? *

Determine maximum purchase price and loan amount I can qualify for

Determine purchase price and loan amount appropriate for my income and lifestyle

Obtain a targeted monthly mortgage payment amount

Purchase a home within a specific budget down payment and closing costs

Ability to sell home, pay down, pay off, or refinance home without penalty

Maximize tax benefits

Include improvements to home in financing

Quality for new home prior to, or without sale of existing home

Consolidate my loans

Renovate my home

Other

Do you work with a financial planner? *

Option One

Option Two

Do you work with a stockbroker? *

Yes

No

Do you work with a life insurance agent? *

Yes

No

Do you have an RRSP or a Pension plan at work?

Yes

No

Do you participate in that plan?

Yes

No

If so, do you maximize your contribution?

Yes

No

Have you put a will in place or established a living trust to protect your family's assets in the event of something happening to you?

Yes

No

If we can show you ways of building wealth faster or becoming debt free more quickly, would you be interested? *

Yes

No

Do you want us to refer you to a trustworthy, professional, ethical, and experienced realtor?

Yes

No