Personal Information

First Name *

Last Name *

Phone *

Email *

City

Province

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Business Information

Business Name

Website

Are you registered as a:

Sole Proprietor

Partnership

Corporation

Do you keep all your personal and business expenses separate?

Yes

No

Financial Information

Debts

Monthly Average Personal Income

Monthly Average Business Income

What is your credit card debts? Totals with interest rates:

Do you have personal loans and how much do you owe?

Do you have business loans and how much do you owe?

Do you have a mortgage and how much is owing- interest rate?

Do you owe on a vehicle loan and how much is owing- interest rate?

Other debts to note with interest rates

Savings & Investments

Savings Balance

Emergency Fund Balance

RRSP/TFSA Savings Balances

Other Investments

Insurance

Do you currently have Insurance coverage? Select all that apply:

Life Insurance

Disability Insurance

Critical Illness

Not sure, have work coverage

None

Do you currently have Business Insurance? Select all that apply:

Liability

Property

Other

Do you have group health benefits for your business employees?

Yes

No

Are you interested in reviewing your insurance coverage?

Goals

What are your top 3 short term financial goals? (3-5 years)

What are your top 3 long term financial goals? (5+ years)

Are you saving for: (Select all that apply)

Retirement

Education

Buying a home

Business growth

Other

Last Questions

What are your biggest financial challenges right now?

Is there anything else you can tell us before we meet?