60 Walnut St Suite 101A Wellesley, MA 02481 Phone 781.772.2450 Fax 781.431.9777 www.balancewealthadvisor.com How did you hear about us? ☐ Social Media (Facebook, LinkedIn, etc.) ☐ Client Events…If so which event ☐ Lunch and Learn ☐ Informational Seminar ☐ Private Client Dinner ☐ Client Referral… If so who referred, you _______ Please list 3 life goals you wish to accomplish. These can be personal or financial, long term or short. • • • What would you like to achieve, accomplish or discuss during your meeting? • • • What are you concerned with financially? Check all that apply. Financial Position Retirement Planning Investment Management ☐ Cash Reserves ☐ Tax Efficient Saving Strategies ☐ Planning and Balancing ☐ Budget/ Expenses ☐ Qualified Plans ☐ Investment Education ☐ Current Liabilities ☐ Post Retirement Cash Flow ☐ Investment Strategies Income Taxes Estate Planning Protection ☐ Tax Planning ☐ Wills and Trusts ☐ Life Insurance ☐ Withholdings ☐ Guardianship of Dependents ☐ Disability Insurance ☐ Deductions ☐ Taxable Estate ☐ Long Term Care Insurance ☐ Qualified Contributions ☐ Charitable Giving Other: 

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