Pre-Appointment Form

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- Pre-Appointment Form

Home
Financial Services
Our Team
Attend an Event
Schedule a Meeting
- Pre-Appointment Form

We are looking forward to getting together with you. If you have any questions or require special assistance prior to your visit, please call our office at 832.559.8777.

Step 1 of 13

The following items would be helpful to have at the time of our visit:
1. All brokerage firm statements
2. All life insurance & annuity policies
3. All IRA & retirement statements
4. 2 Years of Tax Returns
5. Social Security Statement (SSA.gov)
CONTACT INFORMATION
Name
First Last
Nickname
Date of Birth
MM slash DD slash YYYY
Working At/Retired From:
Current/Former Occupation:
Retired?
Spouse Name
First Last
Spouse Nickname
Spouse Date of Birth
MM slash DD slash YYYY
Spouse Working At/Retired From:
Spouse Current/Former Occupation:
Spouse Retired?
Home Phone:
Cell Phone:
Email Address:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Were you referred to us?
If so, by whom?

FAMILY
Number of Children
Number of Grandchildren
Do any of your children or grandchildren have special needs?
Are any of your children or grandchildren listed as joint owners on any of your accounts/assets?
Family Notes:

LEGAL ITEMS
Which of the following legal documents do you have in place?
Will
Power of Attorney (POA) Assets
Power of Attorney (POA) Health
Living Will
Living Trust

LEGAL ITEMS
Which of the following do you have in place?
Umbrella Policy
Long Term Care Insurance
Death Benefit Life Insurance
Life Insurance

CASH FLOW
Please list monthly income from each source.
Pension
You
Your Spouse
(Survivor Options)
You
Your Spouse
Social Security
You
Your Spouse
Wages
You
Your Spouse
Other Income
You
Source(s)
Total
Other Income
Spouse
Source(s)
Total
Are these amounts net or gross?
How much are your monthly expenses?
Here are some common expenses:
Mortgage, Food, Gas, Car Loan, Insurance, Utilities, Gifts/Donations, Medical, Taxes, Social Security, etc
Total

CASH FLOW
Is your current cash flow sufficient and comfortable?
Do you live off interest your investment dollars earn?
Do you anticipate any significant changes in cash flow?
Are you planning any major lifestyle changes?
Do you foresee any large purchases greater than $5,000 within the next 3 years?
Do you contribute to charity?

LIFE EVENTS
In the near future I expect to: (Please check all that apply)
- Buy a home
- Sell a home
- Improve a home
- Retire
- Care for a parent
- Start/Expand a business
- Pay off debt
- Start a part-time job
- Help fund education costs for a family member
- Sell a property
- Receive an inheritance
- Purchase a property
- Other

ASSETS
Please check off the accounts you currently hold and list the total amount in the box provided, and bring the latest statement in for your visit (Optional).
- Bank / Credit Union Accounts
$
- Mutual Funds / Stocks / Bonds
$
- Brokerage Accounts
$
- Retirement Accounts from Work
$
- CDs
$
- Business Interest
$
- Annuities
$
- IRAs / 401K / 401B / Keoghs / TSAs
$
- Life Insurance
$
- Long Term Care Insurance
$
- Promissory Notes / Contract for Deed
$
- Other Assets
$

ASSETS
Property:
Home Value $
Autos and Personal Property $
Rental/Additional Properties $

ASSETS
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY

Additional Information
If you are not already retired, when do you want to retire?
How did you acquire your wealth?
How involved would you like to be with your investments?
What is most important about your money to you?
Are you more concerned about growing your assets or protecting what you already have?

Concerns
Which of the following are your top three concerns?
- Losing too much money in the stock market
- Avoid paying too much in taxes
- Considering retirement and not sure if I/we can afford to
- Not having a reliable income plan for retirement
- Concerned about giving away life savings due to a catastrophic illness
- Outliving nest egg
- Uncertainty about stock market
- Leaving a legacy to children and/or grandchildren
- Need direction with 401K and/or IRA accounts

Objectives
Which of the following describes your risk tolerance when it comes to retirement assets?
What are your Financial Objectives? (Check all that apply)
- Income Now
- Tax-Deferred Growth
- Guarantees Provided
- Pass Assets to Beneficiaries
- Growth Potential
- Other
By submitting your contact information, you consent to be contacted regarding retirement income strategies that utilize investments and insurance products.
Phone
This field is for validation purposes and should be left unchanged.

Contact Us

Phone: 832.559.8777
Fax: 832.559.8787
Email: info@missionretirement.com

Our Location

11619 Spring Cypress Road, Suite B
Tomball, TX 77377
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We are an independent financial services firm helping individuals create retirement strategies using a variety of insurance products and other recommendations to custom suit their needs and objectives.

Investment advisory services offered only by duly registered individuals through Mission Retirement.

Any references to protection benefits or steady and reliable income streams on this website refer only to fixed insurance products. Annuity guarantees are backed by the financial strength and claims-paying ability of the issuing insurance company. Annuities are insurance products that may be subject to fees, surrender charges and holding periods which vary by insurance company.

The purpose of this website is to provide general information on the subjects discussed; it is not intended to be used as the sole basis for financial decisions, nor should it be construed as advice designed to meet the particular needs of an individual’s situation. In order for that to occur, a Retirement Rescue Plan must be created for each individual or couple. Our firm does not provide tax, legal or investment advice; all individuals are encouraged to seek guidance from qualified professionals regarding their personal situation.

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