Schedule a Meeting | Strategic Wealth Designers

Strategic Wealth Designers
9710 Park Plaza Avenue
Suite 210
Louisville, KY 40241
502-412-3354

Schedule a Meeting

Complete the form below and a SWD staff member will contact you!

Name

Address

City

State

Zip Code

Day Phone #

E-Mail

Birthday

Spouse

Spouse B-Day

# of Children

# of Grandchildren


Check if you currently work with a financial adviser Please list name
When did you last meet with your adviser ?
How often do you meet with your adviser ?


Check if you are retired	If no, date for planned retirement
Check if spouse is retired	If no, date for planned retirement
Check if you work part-time	Check if your spouse works part-time
Employer	Position
Spouse's Employer	Position


Please check if you have any of the following:
Will	Living Trust	Living Will
Long Term Care Ins	Disability Insurance	Life Insurance
Durable Power of Att.	Liability Umbrella

My 3 biggest concerns are:

My spouse's 3 biggest concerns are:


List the fair market value of the assets listed below that apply to you:
Residence	$	Mutual Funds	$
Rental Real Estate	$	Stocks	$
Land	$	Savings	$
C.D. 's	$	Money Markets	$
401 (K)	$	Annuities	$
IRA	$	Other	$


Please list your current debts
Home Mortgage	$	Credit Cards	$
Other Real Estate	$	Home Equity Line	$
Vehicle Loans	$	Other	$


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