Eric Wasserman - President & Wealth Advisor
Colin Fernie – Wealth Advisor
Laura Benigno – Client Services Associate
760.924.2600
[email protected] [email protected] [email protected]Client Profile
Account Title: ______________________________________________________________________________________
Client Name: ___________________________________________________________________________
Mailing Address: ________________________________________________________________________
Legal Address (if different): ________________________________________________________________
Home Phone: ________________ Cell Phone: _________________ Work Phone: ___________________
Email Address: _________________________________________________________________________
Social Security Number: ______________________ Trust/Corp/Plan Tax ID: _________________
Date of Birth: ____________ Marital Status: _______________ Dependents (#) ___________
Occupation: ___________________________ Employer (Prior if Retired):______________________
Nature of Business: ___________________ Employer Address: ______________________________
Co-Owner/Trustee Information
Client Name: ____________________________________________________________________________
Mailing Address: _________________________________________________________________________
Legal Address (if different): ________________________________________________________________
Home Phone: ________________ Cell Phone: _________________ Work Phone: ___________________
Email Address: __________________________________________________________________________
Social Security Number: ______________________ Trust/Corp/Plan Tax ID: _________________
Date of Birth: ____________ Marital Status: ________________ Dependents (#) __________
Occupation: ___________________________ Employer (Prior if Retired):______________________
Nature of Business: ___________________ Employer Address: ______________________________
Suitability:
Estimated Annual Income: ____________________ Current Tax Bracket: _____________________
Estimated Liquid Net Worth: _________________ Estimated Total Net Worth: ________________
Primary Source of Income: ___________________
The financial advisors at Mammoth Wealth Management are registered representatives with, and securities and advisory services offered through LPL Financial, a registered investment
advisor, Member FINRA/SIPC.
Investment Experience (# Years):
Annuities _________ Mutual Funds ________ Partnerships ________ Margin _____________
Stocks ___________ Bonds ___________ Options _________ Other (Specify) ______________
Investment Objective:
1. Income with Capital Preservation _______ 2. Income with Moderate Growth ____________
3. Growth with Income __________ 4. Growth ___________ 5. Aggressive Growth _________
Beneficiaries & Custodial Information: (Please use a separate sheet of paper for any additional beneficiaries)
Beneficiaries/TOD
Name 1: _____________________________ Name 2: _________________________________
DOB: _________ SSN: __________________ DOB: _____________ SSN: ________________
Relationship: _________________________ Relationship: ____________________________
Primary/Contingent? Percent: ___________ Primary/Contingent? Percent: _____________
Per Stirpes or Per Capita (circle one) Per Stirpes or Per Capita (circle one)
Name 3: ______________________________ Name 4: _________________________________
DOB: _________ SSN: _________________ DOB: _____________ SSN: _________________
Relationship: _________________________ Relationship: _____________________________
Primary/Contingent? Percent: ___________ Primary/Contingent? Percent: _______________
Per Stirpes or Per Capita (circle one) Per Stirpes or Per Capita (circle one)
Custodial Accounts:
Child’s Name: ___________________________ Child’s Name: ___________________________
DOB: __________________________________ DOB: __________________________________
SSN: ___________________________________ SSN: ___________________________________
ACH:
Bank: __________________________________ Account #: _______________________________
Routing #: ______________________________ Acct Registration: _________________________
Auto Contribution (circle one): Yes No Amount: ___________ Frequency: ___________
Auto Distribution (circle one): Yes No Amount: ___________ Frequency: ___________
The financial advisors at Mammoth Wealth Management are registered representatives with, and securities and advisory services offered through LPL Financial, a registered investment
advisor, Member FINRA/SIPC.
