Premium Wealth Accelerator Application Form

Please answer the following questions to be considered for the Premium Wealth Accelerator.

Full Name

Phone Number

Please indicate your primary income source:

What is your annual income?

How much of your after-tax income are you able to save each month?

How do you feel about using the stock market to grow your wealth?

How much of your monthly income goes toward debt payments? (mortgage, car loan, student loans, etc.)

What areas of wealth building would you like to implement? (click all that apply)

Succession Planning (Will, trust, or estate planning)

Retirement Planning

Tax Strategy

Debt Management

Cash Flow and Spending Plan

Education Saving

Other

Have you worked with a wealth coach or financial professional in the past? If so, what was your experience like?

What would make a financial mentorship program successful for you? Please feel free to provide as much detail as you'd like!

The investment for this group wealth mentorship experience is $5,000. Which of the following describes you?