Request a Financial Consultation

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First Name
Surname
Phone
Mobile
Email
Employer

Current Situation
Total annual income (gross) $
Are your finances
Combined
Separate
NA
Home Value $
Spouse Attended Seminar
Yes
No
NA
Savings $
Shared Goals/Values
Yes
No
NA
Mortgage Amount $
Do you have children?
Yes
No
Other debts including credit card $
If so how old are they?
Do you have a trust?
Yes
No
Retire in less than 2 years
Yes
No
Do you have rental properties?
Yes
No
Do you want us to become your accountant
Yes
No
Maybe
Self Employed?
Yes
No

If self-employed:
Up to date with provisional tax
Yes
No
Financial statements and tax returns done (for most recent year)
Yes
No
Do you want us to critique your structure
Yes
No

Please Tick All Applicable
10 Years + Would You Like To:
Be mortgage free
Buy an investment property
Pay for children's university
Give up work for more than 6 months
Buy a holiday home
Save for retirement
Sell my business
Implement a succession plan
2-5 Year Plan
Replace Car
Overseas holiday
Renovate house
Wedding
Start a family/1 income
Purchase boat
Buy a rental property
Buy a house
Protect wealth
12 month Plan
Pay off credit cards/other debt
Stop living pay day to pay day
Remove money worries from my personal relationships
My partner has more boundaries around money
Not to have to earn more money to get ahead
Have more money available
to be in control of my finances
Tax efficiencies
Have the right tax structures in place
To know that mortgage can be repaid quicker
To know that I will achieve my 3-5 year and 10 year plan
To enjoy spending money (no guilt)
Buy a house
Refinance
Start a family
Current Obstacles to Your Plans Being Achieved
Fritter money away
Credit card + other debt out of control
Good intentions not enough
Feel good spending
Lack of direction
Lack of motivation
No plan
In a tail spin
Spouse/partner has different money values
Earning more money is the only way to get ahead
My partner and I don't agree on money
No allowance for a rain day
Business cash flow issues
Unsuitable staff
Pressing creditors
Behind in IRD obligations

Select One of the Below:
How ready are you to take action?
(Never) 1
2
3
4
5
6 (Now)
What is your current situation
Sinking
Floating
Flying

Source
How did you hear about us?

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