Proposal Request Form

First Name *

Last Name *

Your Date of Birth *

Your Phone *

Your Email *

Tax Filing Status (ex. Joint) *

Spouse's Name *

Spouse's Date of Birth or N/A *

Self-Employed or W2 *

Adjusted Gross Income (AGI) Including RSU's or Capital Gains *

$

Tax Filing State *

Approximate Net Worth *

$

If client has capital gains what are they for and are they long or short term

Who is your financial advisor or CPA? *

Who sent you this questionnaire?

Are you directly involved with any charitable organizations?

How do you like organizations to demonstrate their appreciation for gifts you have made?