Baker Financial Services

Name:

Age:

Phone Number / E-mail :

1. What are your total investable assets?

$0.00 - $249,999
$250,000 - $499,999
$500,000 - $999,999
$1,000,000 or more

2. What percentage of your total investment and retirement assets (excluding real estate and tangible personal property) will this portfolio represent?

Less than 25%
25% to 50%
51% to 75%
76% to 100%

3. Is this portfolio to be managed on a stand-alone basis or will it be coordinated with your other investment holdings?

Stand alone
Coordinated

4. How would you describe your prior investment experience?

None
Moderate
Limited
Extensive

5. What is your primary purpose for investing? (Please select all that apply)

Retirement
Education
Income
Emergency Needs
Long Term Wealth Accumulation
Ensure Independence & Maintain Current Lifestyle

6. How would you describe your investment risk tolerance?

Cautious
Moderate
Aggressive

7. What is your investment time frame for achieving your financial goals?

Short term (1 – 3 years)
Intermediate (4 -10 years)
Long Term (10+ years)

8. What is the maximum loss in any year you could tolerate without changing your investment strategy?

0% - 10%
11% - 15%
16% - 20%
21% - 25%
26% +

9. Almost any portfolio has a risk of loss. How often could you tolerate the loss for the year (indicated in question 8) without changing your investment strategy?

1 out of 3 years
1 out of 4 years
1 out of 5 years
1 out of 10 years
Never

10. How did you hear of Baker Financial Services?

Web Search
Word of Mouth
Existing client referral
Other

11. Would you like a representative of Baker Financial Services to contact you regarding a free initial consultation?

Yes
No

Comments / Questions: