1) Goals *

What is (are) your goal(s) for this portfolio?

Retirement

Major Purchase/Expense

Education Funding

Gift/Donations

Other

2) Investment Time Horizon *

An important consideration is your investment time horizon — the length of time you will remain fully invested. Because of the increased possibility of losses, there should be a minimal allocation to stocks in portfolios with relatively short investment time horizons. How long do you plan to hold this investment portfolio?

Less than 5 Years

5 to 9 years

10 to 19 years

20 years or more

3) Income Needs *

Your current need for income from your portfolio is an important factor in designing your portfolio. How much will you need to withdraw from your portfolio each year?

0%

0 - 2%

2 - 4%

4 - 5%

Over 5%

4) Liquidity / Cash Needs *

Beyond your income needs above, will you need to make significant withdrawals from your portfolio within the next five years to fund major expenses (i.e. college funding, vacation home)? Please indicate the estimated amount of withdrawals as a percentage of your portfolio:

No Additional

Less than 15%

15 - 35 %

35 - 50%

50 - 60%

60 - 75%

75 - 100%

5) Portfolio Returns vs Potential Losses *

What level of returns do you expect from your portfolio and what losses can you withstand? The example is for illustrative purposes only and not representative of any specific investment. The table in the image above shows seven hypothetical portfolios and their greatest 1-year loss and highest 1-year gain for a hypothetical investment of $100,000. Which portfolio would you feel most comfortable with? This example is for illustrative purposes only and is not intended to represent a specific investment or portfolio of investments. The highest 1-year gain and greatest 1-year loss are based on rolling 12 month returns from January 1972 to December 2013 for portfolios represented by Five-Year U.S. Treasury Notes and the S&P 500 Index. Returns assume the reinvestment of dividends and capital gains, but do not include the deduction of management fees or taxes, which will reduce an investor’s returns. Indices are unmanaged and do not reflect the payment of advisory fees and other expenses associated with an investment in a mutual fund or separate account. Investors cannot directly invest in an index. (Please refer to the "Porfolio Returns vs Potential Losses" image to help answer this question.)

Portfolio A

Portfolio B

Portfolio C

Portfolio D

Portfolio E

Portfolio F

Portfolio G

6a) Reaction to Financial Markets *

What has been your personal experience with financial market declines? Consider your feelings during the steep market declines that occurred during the Great Recession when the S&P 500 Index lost more than 40% over a six month period from September 1, 2008 through February 28, 2009. How did you (or would you have) reacted during that period.

I sold/would have sold all of my stock investments.

I sold/would have sold some of my stock investments.

I made/would have made no changes to my stock investments.

I increased/would have increased my stock investments.

6b) Reaction to Financial Markets *

Based on my past investment experience, I tend to sell stock investments and invest the money in safer assets during market declines.

Strongly disagree

Disagree

Somewhat agree

Agree

Strongly agree

7a) Reaction to Fluctuations in Portfolio Values *

How would you react if you lost $50,000 on your $250,000 investment portfolio tomorrow? Please select the statement below that best reflects your reaction to the decline in investment value.

I maintain a long-term focus with my investments and wouldn’t change my investment plan.

I would be very concerned, but probably wouldn’t change my investment plan.

I’m not sure what I would do.

I would probably make a change to my investment plan.

I would definitely make a change to my investment plan.

7b) Reaction to Fluctuations in Portfolio Values *

Generally I prefer a portfolio with little or no fluctuation in value, and I am willing to accept the lower potential returns associated with this type of portfolio.

Strongly disagree

Disagree

Somewhat agree

Agree

Strongly agree

8) International Investment Preference *

International investing can help increase your portfolio’s diversification as it enables you to spread risk across a variety of economies and financial markets. International investments include developed markets, such as France and Germany, with well-established companies and listing standards similar to the U.S., and also include more speculative emerging markets in countries with rapid but volatile economic growth. Which statement best reflects your view on international investing? (Foreign securities involve additional risks, including foreign currency changes, political risks, foreign taxes, and different methods of accounting and financial reporting.)

I am very comfortable with international investments.

I am comfortable with international investments.

I am somewhat comfortable with international investments.

I am somewhat uneasy with international investments.

I am uneasy with international investments.

9) Value Investing *

The style of stock market investing can affect your long-term rate of return. Investing in companies experiencing rapid growth in revenues and profits is called “growth” investing. Investing in companies experiencing slow growth, difficult business conditions, and/or declining revenues and profits is called “value” investing. Historical data suggests the expected returns of value stocks are higher than those of growth stocks in both U.S. and international markets because there are higher risks associated with investing in value stocks. While the stocks of value companies may be likely to outperform over the long term, such investments are also likely to underperform the market for certain periods of time. How comfortable are you with including value company investments in your portfolio? (Value companies have more risk than growth companies and may underperform when the market favors growth companies.)

I am very comfortable with value company investments.

I am comfortable with value company investments.

I am somewhat comfortable with value company investments.

10) Small Company Investing *

Investing in the stocks of smaller, lesser-known companies can also affect long-term returns. Generally, “small” company stocks have a market value that falls within the smallest 10% of the market universe. “Large” company stocks are typically represented by the Standard & Poor’s 500 Index (S&P 500) and include well-established companies with relatively high stock market value. Historical data suggests the expected returns of small company stocks are higher than those of large company stocks in both U.S. and international markets. However, there are higher risks associated with less-established companies, and such investments may underperform the market for certain periods of time. (Small company stocks have additional risks, including greater volatility and less liquidity than stocks of larger companies. All investments involve risk, including loss of principal. Bonds are subject to risks, including interest rate risk, which can decrease the value of a bond as interest rates rise. Small company stocks have additional risks, including greater volatility and less liquidity than stocks of larger companies. Value companies have more risk than growth companies and may underperform when the market favors growth companies. Foreign securities involve additional risks, including foreign currency changes, political risks, foreign taxes, and different methods of accounting and financial reporting. Diversification and buy-and-hold strategies do not guarantee a profit or principal protection.)

I am very comfortable with small company investments.

I am comfortable with small company investments.

I am somewhat comfortable with small company investments.

Name *

First Name

Last Name

Phone *

(###)

###

####

Phone Type *

Home

Cell

Work

Other

Account Type(s)

What type(s) of investable asset accounts would you like to discuss?

Trust / Individual / Joint

Traditional IRA / 401k

Roth IRA

Other

Are you a US Citizen or Registered Permanent Resident? *

We can only work with clients who are US Citizens and Organizations, or people who have "Green Cards" at this time. Unfortunately, if you are not in one of these categories we cannot work together; therefore, there is no need to submit this form.

Yes