About You
First Name
Last Name
Phone Number
Email
Address
City
State
Choose Your State
Zip
Preferred Method of Contact
Email
Phone Call
Tell Us About You
How would you rate your "Tax Efficiency"?
Choose (1 Bad, 10 Great)
1
2
3
4
5
6
7
8
9
10
What is Your Occupation?
Are you Self Employed?
Select an Option
Yes
No
Do You Own and Operate a Corporation / LLC / Partnership?
Select an Option
Corporation
LLC
Partnership
No
Do you Own and Operate Residential or Commercial Real Estate?
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Residential
Commercial
No
Do You Have a Retirement Plan?
Select an Option
Yes
No
Do You Have a Self Directed IRA or 401k?
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Both Self Directed IRA and 401k
Self Directed IRA
Self Directed 401k
No
Do You Have an Estate Plan?
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Yes
No
Are You Familliar with "Tax-Favored Investing"
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Yes
No
Are Your Tax Filings Current?
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Yes
State Current & Federal Past Due
State Past Due & Federal Current
Both State & Federal Past Due
How Far Past Due?
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Less Than 1 Year
1 to 2 Years
2 to 5 Years
Greater Than 5 Years
Do You Have Unpaid Taxes?
Select an Option
Yes
No
How Much Do You Owe?
Select an Option
Less Than $1,000
$1,000 to $2,000
$2,000 to $5,000
$5,000 to $10,000
Greater Than $10,000
Is There Anything Information You'd Like Us to Know?
