Adviser Information
Name: ___________________________________________________________________________________________________
Name under which business is conducted, if different:_________________________________________________________
Address: __________________________________________________________________________________________________
City:________________________________________ State: _____ Zip: _______________Phone: ________________________
About the Adviser’s Practice
1. How many clients do you currently serve?
❏ fewer than 25 ❏ 25 - 50 ❏ 51 - 100 ❏ over 100
2. What is your clients’ most common investment objective? Please rank in order, with 1 being most common
and 4 being least common.
1) ____________________________________ 3) ____________________________________
2) ____________________________________ 4) ____________________________________
3. What is your clients’ most common age range? Please rank in order on a scale from 1 to 4,
with 1 being most common and 4 being least common.
___ under 35 ___ 36 - 50 ___ 51 - 65 ___ over 65
4. What is your clients’ most common income range? (Total income per household before taxes.)
Please rank in order on a scale from 1 to 4, with 1 being most common and 4 being least common.
___ $0 - $35,000 yr. ___ $36,000 - $75,000 yr. ___ $76,000 - $150,000 yr. ___ in excess of $150,000 yr.
5. Do you take discretionary authority over client accounts? ❏ yes ❏ no
If yes, is there an independent review of such accounts? ❏ yes ❏ no How often? __________________
6. Will you provide me with references from clients? ❏ yes ❏ no
Name: ______________________________________________________ Phone: ________________________
Name: ______________________________________________________ Phone: ________________________
Name: ______________________________________________________ Phone: ________________________
7. Will you provide me with a sample copy of a plan or a sample list of recommendations? ❏ yes ❏ no
8.
Please provide me with a current copy of your Form ADV, Part II, or disclosure document.
Experience, Licenses and Education
1. How long have you been offering financial planning or investment advisory services? # _____ years
2. How long have you been registered as an investment adviser or investment adviser representative?
# _____ years with the Securities and Exchange Commission # _____ years with the State of Maryland
3. How many firms have you worked for as an adviser or planner? # _____ firms
Please list names and dates:
________________________________________________ _______________________________________________
________________________________________________ _______________________________________________
________________________________________________ _______________________________________________