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New Client Account Application
General Information
Full Name*
Preferred Name
Date of Birth*
DL Issued State*
Driver’s License #*
DL Issued Date*
DL Expiration Date*
Phone Information
Mobile Phone*
Home Phone
Preferred Phone*
Mobile
Home
Email Information
Personal Email*
Business Email
Email Preference*
Personal
Business
Address Information
Mailing Address*
Preferred Contact Method*
Phone
Email
Mail
Legal Address Same as Mailing?*
Yes
No
Additional Information
Citizenship*
U.S. Citizen
Resident Alien
Non-Resident Alien
U.S. Citizen Living Abroad
Gender*
Male
Female
Other / Prefer not to say
Country of Citizenship*
Marital Status*
Married
Single
Divorced
Widowed
Number of Dependents*
Place of Birth
Employment Info
Employment Status*
Financial Profile
Estimated Annual Income*
Federal Tax Bracket*
0% - 15%
16% - 28%
29% - 33%
34% - 39%
Estimated Net Worth*
Estimated Liquid Net Worth*
Annual Living Expenses*
$0 - $25,000
$25,001 - $50,000
$50,001 - $75,000
$75,001 - $100,000
$100,001 - $250,000
$250,001 - $500,000
> $500,000
Special Upcoming Expenses*
$0 - $25,000
$25,001 - $50,000
$50,001 - $75,000
$75,001 - $100,000
$100,001 - $250,000
$250,001 - $500,000
> $500,000
Time Frame for Special Expenses
Investment Experience
Do you have prior investment experience?*
Yes
No
Estimated Value of This Account*
Account Type*
Non-Retirement
Retirement
College Savings Plan
Other
Ownership Type*
Individual
Joint
Transfer On Death
Other
Advisor Name*
Jonathan Polson
Document Upload
Driver’s License (optional)
Link a Bank Account?*
No
Yes
Yes, I will email a voided check to
jpolson@southerntrustwm.com
Transfer Existing Account?*
No
Yes
Yes, I will email my most recent statement to
jpolson@southerntrustwm.com
Account Owned by a Trust?*
No
Yes
Yes, I will email my trust document to
jpolson@southerntrustwm.com
Review and Submit
Fillable STWM Fact Finder
Five Steps to a Confident Retirement