Palen Financial’s Data Gathering Form

This form must be completed and submitted before the free initial
consultation in order for the meeting to take place.
It must be completed by the household
decision maker(s) and the initial consultation must include both spouses

The following documents MUST  accompany you at your initial meeting for an accurate analysis to be completed:

  • Last Year’s Tax Return
  • Brokerage Firm Statements
  • Life Insurance/Annuity Statements & Policies
  • IRA/401k and other Investment Statements
  • Will and/or Trust Documents

Family Information

 Yes No
 Yes No

Personal Questions

 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No

Financial Planning Objectives

1 = being the least concerned5 = being the most concerned
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5
 1 2 3 4 5

Real Estate

Select Ownership Type: H=Husband W=Wife JT=Joint or Trust
 H W JT
 H W JT
 H W JT

Sources of Monthly Earned and Retirement Income

You
Spouse
You
Spouse
You
Spouse
TOTAL

Contact us today for an examination of your portfolio – our “Financial Fresh Look”!

You can start your examination by filling out and submitting the Data Gathering form below.  The Expense Sheet is optional.