CONFIDENTIAL FINANCIAL SURVEY
Olson Financial Counsel LLC is a fee-only investment management firm that helps long-
term investors achieve maximum investment return without unwanted risk. Your careful
responses to this survey will help us design and propose an investment program with
better return potential with less risk and less cost than what you are presently doing.
Please return your completed survey to:
Mr. Peter Olson, President and
Investment Adviser Representative of
Olson Financial Counsel LLC
Mail: Post Office Box 665 | Dubuque, IA 52004-0665
adviser@ofcllc.com | (563) 564-3717 | www.ofcllc.com
FINANCIAL GOALS AND PREFERENCES
What prompted you to seek my help, and what can I help you accomplish?
If you have worked with an adviser before, please tell me about your experience.
What do you want from your adviser that you’re not getting now?
What past financial decisions turned out very well or beneficially for you?
What past financial decisions would you make differently, in hindsight?
If you decided that you were financially well off, what sorts of things would you do more of? Less of?
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INVESTMENT PROFILE
A. As an investor, how would you describe yourself?
1) ___ Very new to investing.
2) ___ Somewhere in the middle.
3) ___ Very experienced at investing.
B. Do you expect your income or net worth to decline for any reason during the next:
1) ___ 1-2 years
2) ___ 2-5 years
3) ___ 5-10 years
4) ___ 10+ years
C. What kinds of savings do you keep accessible for short-term unexpected financial needs?
1) ___ $1,000 or less saved.
2) ___ Enough cash to cover 1-3 months’ expenses.
3) ___ Enough cash to cover 3-6 months’ expenses.
4) ___ Enough cash to cover 6+ months’ expenses.
D. How long do you plan to invest the majority of your accounts?
1) ___ Less than a year.
2) ___ 1-3 years.
3) ___ 3-7 years.
4) ___ 7-10 years.
5) ___ 10+ years.
E. Realistically, how do you want to see your investment(s) grow? Will you add to this investment?
1) ___ Slowly and steadily. 1) ___ No, not planning to.
2) ___ Moderately. 2) ___ Yes, but not for a while.
3) ___ Very quickly. 3) ___ Yes, sooner than later.
F. How much are you willing to watch your investment(s) rise and fall in value?
1) ___ Not at all (no change in value).
2) ___ A little (up to 5% fluctuation).
3) ___ A fair amount (5-10% fluctuation).
4) ___ Quite a bit (10-25% fluctuation).
5) ___ A lot (25% or greater fluctuation).
G. What average annual return do you want to seek over a 3-5 year period?
1) ___ 1-2% average annual return
2) ___ 3-5% average annual return
3) ___ 6-8% average annual return
4) ___ 9-10% average annual return
5) ___ 10%+ average annual return
Please list below any industries you wish NOT to profit from.
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(Office Use Only: 1-9 Conservative | 10-17 Moderate | 18-25 Moderate-Aggressive | 26+ Aggressive)
PERSONAL INFORMATION
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Your name __________________________ Mailing Address _________________________________
Best phone to reach you _____________________ Best email to reach you _______________________
SSN (not needed now) DOB ___________ Occupation _______________ Employer ____________
Business name and address, if self-employed ____________________________________
Employer address ___________________________________ Best time to reach you ______________
Spouse’s name _______________________ Mailing Address ________________________________
Best phone to reach you _____________________ Best email to reach you ______________________
SSN (not needed now) DOB ___________ Occupation _______________ Employer ____________
Business name and address, if self-employed ________________________________
Employer address __________________________________ Best time to reach spouse ____________
2009 tax filing status _________________ Your realistic retirement date ________ Spouse’s ________
Annual household income ____ $30-50k ____ $40-60k ____ $60-80k ____ $80-120k ____ $120k+
Please list children or any other people, including their ages, that depend on you financially.
___________________________ | __________________________ | ___________________________
___________________________ | __________________________ | ___________________________
If you and/or your spouse have a will, when was it last updated? _________ Yours _______ Spouse’s
Please provide a copy of any item checked below:
__x__ Investment account statements _____ Trust account statements
__x__ Insurance or annuity statements __x__ Loan account statements
__x__ Recent tax return _____ Trust agreements
_____ Business agreements __x__ Marital agreements
_____ Paycheck stub(s) showing withholdings __x__ Employment agreements
__x__ Any other materials /information that bears on your current or future financial situation.
What other important information should I know about you before working together professionally?
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