Potential Client Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What estate planning services are you interested in?
Attorney reserves the right to price differently from below based on the complexity of and customization necessary for your circumstances discussed in the free initial consultation.
How did you hear about us?
Word of Mouth
Social Media
Search Engine
Referral
Spouse Name
First Name
Last Name
Spouse Email
Spouse Phone
(###)
###
####
Spouse Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Do you have an existing estate plan?
Do you or your spouse have children from a prior marriage/relationship?
Your and your spouse's (if applicable) bank accounts are owned:
Individually
Jointly
Both/Some of each
Unknown
No bank accounts
Are beneficiaries named on your and your spouse's (if applicable) life insurance policies?
Are beneficiaries named on your and your spouse's (if applicable) retirement plans?
Your and your spouse's (if applicable) vehicles are owned:
Individually
Jointly
Joint with Right of Survivorship
A mix
Unknown
No vehicles
Is there a loan on any vehicle?
Property 1 Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Property 1 is owned:
Individually
Tenants by the Entirety (Jointly purchasedwith current spouse)
Tenants in Common
Joint with Right of Survivorship
Unknown
Are there any known mortgages or liens on Property 1?
Property 2 Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Property 2 is owned:
Individually
Tenants by the Entirety (Jointly purchasedwith current spouse)
Tenants in Common
Joint with Right of Survivorship
Unknown
Are there any known mortgages or liens on Property 2?
List any additional properties:
If married, do you intend to leave everything to your spouse?
If not everything will be left to your spouse, if your spouse pre-deceases you, or if unmarried, to whom and in what shares do you wish to leave your estate assets?
Please list any specific bequests (what assets and to whom):
Do you wish to disinherit any heirs at law and, if so, who?
If any beneficiaries (or potential future beneficiaries if your named beneficiaries may have children) are under 21 years old, at what age do you wish for them to receive full control of their inheritance?
If a beneficiary dies before you, how do you want that beneficiary's share to be distributed?
List all people or entities (e.g. charities) to whom you wish to leave estate assets.
Please list beneficiaries' full names, ages, relationship to you (e.g. daughter, son, etc.), and any specific concerns (e.g. if a beneficiary has special needs or cannot handle money for any reason).
Executor
Complete executor information if you wish to have a will drafted.
First Name
Last Name
Phone
(###)
###
####
Alternate Executor
First Name
Last Name
Phone
(###)
###
####
Shall executors act individually or jointly as co-executors?
Trustee
Complete trustee information if you wish to have a trust drafted.
First Name
Last Name
Phone
(###)
###
####
Alternate Trustee
First Name
Last Name
Phone
(###)
###
####
Shall trustees act individually or jointly as co-trustees?
Before the trust assets are fully distributed, how do you want the trustee to use trust assets/funds?
You can restrict the trustee to use the funds for specific purposes such as the health, education, or maintenance of the beneficiaries, or you can give the trustee full discretion.
General Power of Attorney - Agent Information
Complete agent information if you wish to have a general power of attorney drafted. This document is only effective while you are alive. This gives your agent/attorney-in-fact power to act for you in legal or financial matters as you choose.
First Name
Last Name
Phone
(###)
###
####
Alternate Agent
First Name
Last Name
Phone
(###)
###
####
Shall agents act individually or jointly as co-agents?
When do you want your agent to have power over your affairs?
Health Care Power of Attorney - Health Care Agent Information
Complete health care agent information if you wish to have a health care power of attorney drafted. This document is only effective while you are alive. This gives your agent/attorney-in-fact power to act for you in medical matters as you choose.
First Name
Last Name
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Alternate Health Care Agent
First Name
Last Name
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Shall health care agents act individually or jointly as co-agents?
Please let us know if there is any additional information or if you have any specific questions.
