Proposal Request Form

First Name *

Last Name *

Your Phone *

Your Email *

Your Date of Birth *

Tax Filing Status (ex. Joint) *

Select filing status

Spouse's Name *

Spouse's Date of Birth or N/A *

Earned Income *

$

Short-Term Capital Gains *

$

Long-Term Capital Gains *

$

Tax Filing State *

Select state

Approximate Net Worth *

$

Loan Repayment Options *

Personal Guarantee (UCC1)

No Personal Guarantee (Collateralized by Life Insurance)

Top 3 Charitable Inclinations *

Who is your financial advisor or CPA? *

Who sent you this questionnaire? (optional)

Proposal Preferences or Special Instructions (optional)

I agree to be contacted by Wealth Excel about my personalized Charitable Gift Financing proposal. I can unsubscribe at any time.