Investment Profile Questionnaire



Client Profile

Please Complete this two page profile and email to info@ or bring it with you to your appointment.

(Mr. Mrs. Ms)

|Your Name | Nickname |Age |Birth date (mm/dd/yyyy) |

| | | | |

|(Mr. Mrs. Ms) | | | |

|Spouse’s Name | Nickname |Age |Birth date (mm/dd/yyyy) |

|Residence Address |City |State |Zip |

|Mailing Address |City |State |Zip |

|Home Phone | Cell Phone | E-mail Address | |

| |Fax | | |

|How did you hear about us? | | | |

|Your Job Title (occupation) | Employer (last, if retired) |City & State # | |

| | |of Years |Retirement Date |

|Spouse’s Job Title (occupation) | Employer (last, if retired) | City & State # | |

| | |of Years |Retirement Date |

|Planned Retirement Age: ____ |Retirement Income: $ |Legacy for Heirs: $ |

What are your major objectives for your investments?

□ Current and future income □ Keeping ahead of inflation

□ Preserving capital □ Increasing returns

□ Building wealth for heirs

|Investment Goals Low Priority High Priority |

|Return should exceed inflation rate |1 |2 |3 |4 |

|Client Signature | |Date | |Print Name |

| | | | | |

|Client Signature | |Date | |Print Name |

Any rates of return shown are for illustrative purposes only and are neither guaranteed nor implied. 

Actual rates of return will be based upon the actual performance of selected investments. 

Taxes and fees are not a consideration in the illustrated returns.

Securities offered through Kalos Capital, Inc. located at 11525 Park Woods Circle, Alpharetta, Georgia 30005, (678) 356-1100,  TD Ameritrade Institutional Services located at 5010 Wateridge Vista Dr., San Diego, California 92121 (800) 431-3500,  Fidelity located at 100 Crosby Pkwy, Covington, KY 41015, 800-544-5555,  and investment advisory services offered through Beacon Capital Management, a Registered Investment Advisor with the Tennessee Securities Division. Beacon Capital Management is neither an affiliate nor subsidiary of  Kalos Capital, Inc. or TD Ameritrade Institutional Services, or Fidelity,  and does not provide tax and legal services.

Thank You

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BASIC INFORMATION:

OCCUPATION:

GOALS:

INVESTOR EXPERIENCE & HISTORY:

RISK PROFILE:

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