Form

LEGACY Financial Life Professional Contact Information
LEGACY FLP Name*
LEGACY FLP Email Address*
LEGACY FLP Mobile Phone*
Contact Information
This is the information that our service providers will use to contact the client
Please make sure to fill-out all required fields. Put N/A if not applicable.
Client First Name*
Client Last Name*
Address*
Address 2
City*
Postal Code*
Phone*
Email*
Date of Birth*
Client Real Estate Details
Do you own a personal residence?*
If Yes what is your mortgage amount: $*
Line of credit amount (HELOC): $*
Line of credit (HELOC) monthly payment: $*
Property tax amount: $*
Assessed value of residence: $*
Monthly mortgage amount: $*
Do you own a rental property portfolio?*
Market value of current portfolio: $*
Total monthly mortgage payments on rental portfolio: $*
Gross monthly rental income: $*
Total property tax on rental portfolio: $*
Total outstanding debt obligations (1st mortgage, 2nd mortgage,*
Client Personal Wealth Details
Total household income: $*
Total RSP investments: $*
Non RSP investments (TFSAs, stocks, mutual funds, other): $*
Credit card balance: $*
Credit card monthly payments: $*
Loans balance: $*
Loans monthly payments: $*
Line of credit balance: $*
Line of credit monthly payments: $*
Select the Client Service Provider(s)
HOME EQUITY BANK

HOME EQUITY BANK
Are you above the age of 55?
Do you own your personal residence free-and-clear?
Purpose of funds:
FINANCE

FINANCE
REALTY

REALTY
Are you currently working with a REALTOR?
Are you looking to buy or sell property?
If buying, do you have financing in place?
What type of property are you looking to buy or sell?
WEALTH

WEALTH
Other

Other
Other Service Request
Financial Life Professional notes for Service Provider
Confirmation of informed consent
Referral requires completed consent form. Please Put full Name below if everything above is true.
Signature*
Signed Consent Form*

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LEGACY Financial Life Professional Contact Information

Contact Information

Client Real Estate Details

Client Personal Wealth Details

Select the Client Service Provider(s)

Confirmation of informed consent