Name *

First Name

Last Name

Primary Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

MM

DD

YYYY

Investment Objective *

What is your objective of contacting us today?

Sharing your wealth through estate strategies

Transitioning into a major life event

Optimizing your retirement

Insurance planning for the unexpected

Planning for major expenditures

Maximizing your business success

Debt and refinancing

Income *

What is your current annual household income?

Less than $100,000

$100,000 to $249,999

$250,000 to $499,999

More than $500,000

Investment Knowledge *

Which statement best describes your knowledge of investments?

Novice: Limited to no knowledge of the basic characteristics of investments and financial markets

Fair: Some investment experience but not a complete or basic understanding of investments and the risks of investing

Good: Solid understanding of investments and the risk of investing

Excellent: Experience with most types of investments, knowledge of speculative strategies and the risk and rewards involved in trading various investment types

What is your estimated current value of investments? *

Less than $250,000

$250,000 to $499,999

$500,000 to $999,999

More than $1,000,000

What is your estimated total liabilities (mortgage, loans, lines of credit, business debt)? *

Less than $250,000

$250,000 to $499,999

$500,000 to $999,999

More than $1,000,000

What is the value of your liquid assets?

Liquid assets are assets that you can redeem for cash quickly and easily for the purpose of covering a shortfall, an unexpected expense, or a short term goal.

Less than $250,000

$250,000 to $499,999

$500,000 to $999,999

More than $1,000,000

Express Consent *

By providing my email address, I CONSENT to IG Wealth Management using this information to contact me for planning purposes. WE are committed to keeping personal information confidential. By providing us with names and information of other persons you understand that we may contact these persons for similar purposes.

I AGREE