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Custom Intake Form

General Info

*Name:

Spouse Name (if applicable):

*Address:

*City:

*State:

*Zip:

*Home Phone:

Cell Phone:

Fax:

*E-mail address:

How did you hear of us?

Referral (list name)

Business/Employer Name:

Business/Employer Phone:

Business/Employer Address:

Do you have a tax controversy problem (audit, collection), or are you interested in tax and estate planning/asset protection?

Tax Controversy

Did you notice from the IRS or from a creditor?
Yes  No 

If yes, what was it for?

Please list any deadlines or court dates (if any)

What tax years and type of tax (income, employment, etc.)?

How much does the IRS say you owe?

Tax and Estate Planning

Are you interested in selling property and deferring/eliminating capital gains and estate taxes? If so,

Describe the Property

Approximate Value

When is the anticipated sale?

Have the sellers signed a buy/sell agreement or a real estate sales contract? (It is best to transfer the property to the trust before signing the buy/sell agreement)
Yes  No 

How is the property owned?

What is the estimated fair market or resale value of the property? (after commissions, fees, etc. are paid)

List all loans and/or mortgages that will be paid from the sale proceeds.

International Asset Protection

Are you interested in protecting your assets through the proper use of an international trust? If so,

What is the approximate value of your estate?

Do you have existing creditors with liens or judgments?
Yes  No 

Has suit been filed against you?
Yes  No 

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