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Kahler Financial Financial Planning, Rapid City, SD

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Initial Interview Form

To make the best use of our time together please complete and return this form to us before our meeting.

Initial Interview Form

Date:

Name Person 1:*

First

Last

Current Age Person 1:*

E-mail Person 1:*

Phone Person 1:*

Area Code

Phone Number

Profession Person 1:*

Employer Person 1:*

Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Name Person 2:

First

Last

Current Age Person 2:

Phone Person 2:

Area Code

Phone Number

E-mail Person 2:

Employer Person 2:

Profession Person 2:

1/5

Do you have a will?

Yes

Do you have a Living Trust?

Yes

Do you have Life insurance?

Yes

Whole Life ($):

Term ($):

Do you have an asset protection trust?

Yes

Do you have long-term care insurance?

Yes

Do you own any real estate in your own name?

Yes

Do you Track Personal Expenses?

Yes

What do you use to track your personal expenses?

Quickbooks

Quicken

MSN Money

Manually

Do you have a retirement plan?

Yes

Retirement Plan Type:

IRA

401K

MPPP

DB Plan

Other

Do you have a small business?

Yes

Type of Business:

Sole Proprietor

Partnership

LLC

S-Corp

C-Corp

Other

Have you Funded your Children's Education?

Yes

Education Funding:

UGTMA

529

Coverdell

Personal Savings

Other

2/5

INCOME

**Please use whole numerical values only, not symbols, commas or decimals.

Salary/Wage Income (Before Taxes):*

Social Security/Pension Income (Before Taxes):*

Annual Savings/Retirement Plan Contributions:*

ASSETS

**Please use whole numerical values only, not symbols, commas or decimals.

Annuities:

Savings, Money Market, CDs

College Savings (529/Coverdell Plans)

Taxable Investments (Stocks, Bonds, Options, REITS, Mutual Funds

Employer Pensions Plans (Defined Benefit, MPPP, Profit Sharing)

Investment Real Estate (Office Buildings, Rental Properties)

IRAs, Roth IRAs, SEPs

401K, 403b, 457, TSP, Simple

Personal Property:

Closely Held Business Interests(Partnerships, Corporations, Limited Partnerships)

Home

Second, Vacation Homes

Total Assets**:

**If TOTAL ASSETS is blank, please check the fields in the assets section to make sure you only used numerical values, no symbols, commas, or decimals.

LIABILITIES

**Please use whole numerical values only, not symbols, commas or decimals.

Home Mortgage (First, Seconds, HELOCs)*

Consumer Loans (Credit Cards, Student Loans, Car Loans, Etc.)

Investment Real Estate or Business Loans

Total Liabilities:

**If TOTAL LIABILITIES is blank, please check the fields in the liabilities section to make sure you only used numerical values, no symbols, commas, or decimals.

NET WORTH

Total Net Worth (Assets less Liabilities)

3/5

Please prioritize the financial assistance you are seeking (1-Top Priority, 2-Second....6-lowest):

Asset & Income Protection

Investment Strategy Planning

Retirement Planning

Financial Coaching/Counseling

Cash Flow Management (i.e. Spending Plan, Budgeting)

Estate Planning

Total: 0/21

Tell us about your most important financial concerns and what you would like to accomplish through this engagement.

Tell us about your most important non-financial concerns right now?

Describe how you envision your lifestyle 5 years from now. (What are you doing or becoming, where, how, etc)

Describe previous experiences working with financial advisors. What was good/unsatisfactory?

Tell us how you make important investment decisions?

4/5

Tell us about future financial changes that you wish to plan for. (i.e.Family obligations /inheritances...)

During our review 3 years from now, what will need to have happened for you to be satisfied with your progress?

Tell us about past Litigation involvements. What happened?

Describe your ideal relationship with a financial planner.

Is there anything else we need to talk about? Any "special needs" situations you are responsible for?

Where did you hear about us?

5/5

Kahler Financial Group, Inc., is an Investment Adviser registered with the SEC. Advisory services are only offered to clients or prospective clients where Kahler Financial Group, Inc., and its representatives are properly licensed or exempt from licensure. Kahler Financial Group, Inc., will give advice only if they are licensed or otherwise qualified under state and federal laws to do so. This website is solely for informational purposes. No advice may be rendered by Kahler Financial Group, Inc., unless a client service agreement is in place. Kahler Financial Group, Inc., provides links for your convenience to websites produced by other providers or industry related material. Kahler Financial Group, Inc. is not responsible for errors or omissions in the material on third party websites, and does not necessarily approve of or endorse the information provided.

For questions or to report any problems, please contact us.

Kahler Financial Group

1010 9th Street, Suite 1

Rapid City, SD 57701

Tel: (605) 343-1400

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