clientdata.spfadvisors.com Open in urlscan Pro
160.153.61.192  Public Scan

Form analysis
1 forms found in the DOM

POST

<form class="dataclientform" action="" method="post">
  <div class="contact-information">
    <h4 class="display-5" style="font-size: 20px; font-weight: 400;">PLEASE CHOOSE THE CLIENTS TAX FILING STATUS</h4>
    <div style="padding: 10px; border: 2px solid #bdbdbd;">
      <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="cinfotxst1" id="cinfotxst1" value="SINGLE">
        <label class="form-check-label" for="cinfotxst1">SINGLE</label>
      </div>
      <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="cinfotxst2" id="cinfotxst2" value="HEAD OF HOUSEHOLD">
        <label class="form-check-label" for="cinfotxst2">HEAD OF HOUSEHOLD</label>
      </div>
      <div class="form-check form-check-inline">
        <input class="form-check-input" type="radio" name="cinfotxst3" id="cinfotxst3" value="MARRIED">
        <label class="form-check-label" for="cinfotxst3">MARRIED</label>
      </div>
    </div>
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Contact Information</th>
        </tr>
        <tr>
          <th></th>
          <th>Client</th>
          <th>Spouse</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <th>First Name</th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclfn">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfospfn">
          </td>
        </tr>
        <tr>
          <th>Last Name</th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclientln">
          </td>
        </tr>
        <tr>
          <th>Birth Date</th>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclbirthdate">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfospbirthdate">
          </td>
        </tr>
        <tr>
          <th>Phone</th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclphone" data-mask="(000) 000-0000" pattern="/^(\d{3})(\d{3})(\d{4})$/">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfospphone" data-mask="(000) 000-0000" pattern="/^(\d{3})(\d{3})(\d{4})$/">
          </td>
        </tr>
        <tr>
          <th>Email</th>
          <td>
            <input type="email" class="form-control-plaintext" name="cinfoclemail">
          </td>
          <td>
            <input type="email" class="form-control-plaintext" name="cinfospemail">
          </td>
        </tr>
        <tr>
          <th>Street Address</th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclientln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclientln">
          </td>
        </tr>
        <tr>
          <th>City, State, Zip</th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclientln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclientln">
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="professional-contact-information">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Professional Contact Information</th>
        </tr>
        <tr>
          <th>Profession</th>
          <th>Name</th>
          <th>Email Address</th>
          <th>Telephone</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <th>Accountant</th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclfn">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfospfn">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfospfn">
          </td>
        </tr>
        <tr>
          <th>Estate Planning Attorney</th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclientln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfospfn">
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="other-information">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Other Information</th>
        </tr>
        <tr>
          <th>Question</th>
          <th>Yes</th>
          <th>No</th>
          <th>Updated</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <th>Do you own health insurance?</th>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <th>Do you own disability insurance?</th>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <th>Have you named your beneficiaries?</th>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <th>Do you have a will?</th>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <th>Do you have a trust?</th>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input class="form-check-input" type="radio" name="exampleRadios" id="exampleRadios1" value="option1" checked="">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="family-information">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Family Information</th>
        </tr>
        <tr>
          <th>Name</th>
          <th>Relationship</th>
          <th>Date of Birth</th>
          <th>Spouse’s Name</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="beneficiary-information">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Beneficiary Information</th>
        </tr>
        <tr>
          <th>Name</th>
          <th>Relationship</th>
          <th>Date of Birth</th>
          <th>Address</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="goals">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Goals</th>
        </tr>
        <tr>
          <th width="25%">Date</th>
          <th>Description</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="notes">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Notes</th>
        </tr>
        <tr>
          <th width="25%">Date</th>
          <th>Description</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="date" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="software-tab-1-income">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Software Tab 1 - Income</th>
        </tr>
        <tr>
          <th colspan="100%">Employment Income</th>
        </tr>
        <tr>
          <th></th>
          <th>Client 1</th>
          <th>Client 2</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <th>Employer</th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <th>Current Gross Monthly Salary</th>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <th>Projected Annual Salary Increase %</th>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
        </tr>
        <tr>
          <th>Projected Retirement Date</th>
          <td>
            <div class="row">
              <div class="col-8">
                <input type="date" class="form-control-plaintext">
              </div>
              <div class="col-4">
                <div class="form-check">
                  <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
                  <label class="form-check-label" for="flexCheckDefault"> Retired </label>
                </div>
              </div>
            </div>
          </td>
          <td>
            <div class="row">
              <div class="col-8">
                <input type="date" class="form-control-plaintext">
              </div>
              <div class="col-4">
                <div class="form-check">
                  <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
                  <label class="form-check-label" for="flexCheckDefault"> Retired </label>
                </div>
              </div>
            </div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="social-security-benefits">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Social Security Benefits</th>
        </tr>
        <tr>
          <th>Owner</th>
          <th width="25%">Strategy</th>
          <th>Start Age</th>
          <th>Life or End Age</th>
          <th>Gross Monthly Benefit</th>
          <th>Projected COLA</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <th><input type="text" class="form-control-plaintext" name="cinfoclln"></th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="row">
              <div class="col-5">
                <div class="form-check">
                  <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
                  <label class="form-check-label" for="flexCheckDefault"> Life or </label>
                </div>
              </div>
              <div class="col-7">
                <input type="text" class="form-control-plaintext">
              </div>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
        </tr>
        <tr>
          <th><input type="text" class="form-control-plaintext" name="cinfoclln"></th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="row">
              <div class="col-5">
                <div class="form-check">
                  <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
                  <label class="form-check-label" for="flexCheckDefault"> Life or </label>
                </div>
              </div>
              <div class="col-7">
                <input type="text" class="form-control-plaintext">
              </div>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
        </tr>
        <tr>
          <th><input type="text" class="form-control-plaintext" name="cinfoclln"></th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="row">
              <div class="col-5">
                <div class="form-check">
                  <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
                  <label class="form-check-label" for="flexCheckDefault"> Life or </label>
                </div>
              </div>
              <div class="col-7">
                <input type="text" class="form-control-plaintext">
              </div>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
        </tr>
        <tr>
          <th><input type="text" class="form-control-plaintext" name="cinfoclln"></th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="row">
              <div class="col-5">
                <div class="form-check">
                  <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
                  <label class="form-check-label" for="flexCheckDefault"> Life or </label>
                </div>
              </div>
              <div class="col-7">
                <input type="text" class="form-control-plaintext">
              </div>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="pension-or-employer">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Pension or Employer Sponsored Retirement Plan</th>
        </tr>
        <tr>
          <th>Owner</th>
          <th width="15%">Description</th>
          <th>Start Age</th>
          <th>Life or End Age</th>
          <th>Gross Monthly Benefit</th>
          <th>Projected COLA</th>
          <th>% to Survivor</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <th><input type="text" class="form-control-plaintext" name="cinfoclln"></th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="row">
              <div class="col-5">
                <div class="form-check">
                  <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
                  <label class="form-check-label" for="flexCheckDefault"> Life or </label>
                </div>
              </div>
              <div class="col-7">
                <input type="text" class="form-control-plaintext">
              </div>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
        </tr>
        <tr>
          <th><input type="text" class="form-control-plaintext" name="cinfoclln"></th>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="row">
              <div class="col-5">
                <div class="form-check">
                  <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
                  <label class="form-check-label" for="flexCheckDefault"> Life or </label>
                </div>
              </div>
              <div class="col-7">
                <input type="text" class="form-control-plaintext">
              </div>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
              <span class="input-group-text" id="addon-wrapping">%</span>
            </div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="software-tab-2-assets">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Software Tab 2 - Assets</th>
        </tr>
        <tr>
          <th colspan="100%">Retirement Assets</th>
        </tr>
        <tr>
          <th>Owner</th>
          <th>Company</th>
          <th>Tax Classification IRA, 401k, etc</th>
          <th>Investment Vehicle CD, Bond etc</th>
          <th>Allocation</th>
          <th>Account Value</th>
          <th>Monthly Contributions</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="retirement-assets">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Retirement Assets Continued</th>
        </tr>
        <tr>
          <th>Owner</th>
          <th>Company</th>
          <th>Tax Classification IRA, 401k, etc</th>
          <th>Investment Vehicle CD, Bond etc</th>
          <th>Allocation</th>
          <th>Account Value</th>
          <th>Monthly Contributions</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckDefault">
              <label class="form-check-label" for="flexCheckDefault"> Low Risk </label>
            </div>
            <div class="form-check">
              <input class="form-check-input" type="checkbox" value="" id="flexCheckChecked">
              <label class="form-check-label" for="flexCheckChecked"> At Risk </label>
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
          <td>
            <div class="input-group flex-nowrap">
              <span class="input-group-text" id="addon-wrapping">$</span>
              <input type="text" class="form-control-plaintext" aria-describedby="addon-wrapping">
            </div>
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <div class="additional-assets">
    <table class="table table-responsive table-bordered">
      <thead>
        <tr>
          <th colspan="100%">Additional Assets</th>
        </tr>
        <tr>
          <th>Owner</th>
          <th>Company</th>
          <th>Description</th>
          <th>Value</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
        <tr>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
          <td>
            <input type="text" class="form-control-plaintext" name="cinfoclln">
          </td>
        </tr>
      </tbody>
    </table>
  </div>
  <button type="submit" class="btn btn-primary" name="dataclientformsubmit">Submit</button>
</form>

Text Content

DATA CLIENT FORM

PLEASE CHOOSE THE CLIENTS TAX FILING STATUS

SINGLE
HEAD OF HOUSEHOLD
MARRIED

Contact Information Client Spouse First Name Last Name Birth Date Phone Email
Street Address City, State, Zip

Professional Contact Information Profession Name Email Address Telephone
Accountant Estate Planning Attorney

Other Information Question Yes No Updated Do you own health insurance? Do you
own disability insurance? Have you named your beneficiaries? Do you have a will?
Do you have a trust?

Family Information Name Relationship Date of Birth Spouse’s Name

Beneficiary Information Name Relationship Date of Birth Address

Goals Date Description

Notes Date Description

Software Tab 1 - Income Employment Income Client 1 Client 2 Employer Current
Gross Monthly Salary
$
$
Projected Annual Salary Increase %
%
%
Projected Retirement Date
Retired
Retired

Social Security Benefits Owner Strategy Start Age Life or End Age Gross Monthly
Benefit Projected COLA
Life or

$
%
Life or

$
%
Life or

$
%
Life or

$
%

Pension or Employer Sponsored Retirement Plan Owner Description Start Age Life
or End Age Gross Monthly Benefit Projected COLA % to Survivor
Life or

$
%
%
Life or

$
%
%

Software Tab 2 - Assets Retirement Assets Owner Company Tax Classification IRA,
401k, etc Investment Vehicle CD, Bond etc Allocation Account Value Monthly
Contributions
Low Risk
At Risk
$
$
Low Risk
At Risk
$
$
Low Risk
At Risk
$
$
Low Risk
At Risk
$
$
Low Risk
At Risk
$
$
Low Risk
At Risk
$
$
Low Risk
At Risk
$
$

Retirement Assets Continued Owner Company Tax Classification IRA, 401k, etc
Investment Vehicle CD, Bond etc Allocation Account Value Monthly Contributions
Low Risk
At Risk
$
$
Low Risk
At Risk
$
$
Low Risk
At Risk
$
$

Additional Assets Owner Company Description Value

Submit
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