Pre-Consult Questionnaire:
Our goal is to establish a long and mutually beneficial relationship with you. To do so, we ask that you take a brief moment to complete the
form below. This will provide us the opportunity to learn more about you and your unique financial goals and needs.
I. Client Profile
Client Name:
Preferred Phone Number:
Email Address:
Address:
II. Financial Objectives
a. What does your investment portfolio currently consist of?
Bonds
CDs
Stocks
Currency
Annuities
Futures
Precious Medals
Real Estate
b. Why are you seeking alternative investment opportunities?
c. What type of returns is your portfolio currently yielding on an annual basis?
Less -2%
3% - 5%
6% - 9%
10% +
d. How would you describe your investment strategy?
Preserve Capital
Grow and perhaps, draw regular income from my account
Aggressively grow my account to maximize its value
e. Additional information you believe is important
HIS Capital Group, LLC and any of its affiliates, employees and/or any associated third parties do not guarantee the repayment of inves Y