Contact Information for the Grantor

*NOTE* Completion of this form is for information – gathering only. It does not constitute a binding contract for service. Once we’ve received your intake form, we will contact you to schedule an initial consultation.

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Full Legal Name (as on ID) *

First

Last

Email address *

Date of Birth *

State of Residence *— Select Choice —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Phone *

Address *

City *

State *— Select Choice —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP Code *

Marital/Family Status— Select Choice —SingleMarriedDivorcedWidowedDomestic Partner

Spouse/Partner Full Name (if applicable)

Beneficiary 1 *

First

Last

DOB *

Relationship *

(check how life).

Beneficiary 2

First

Last

DOB

Relationship

Proposed Trust Name

Governing Law State— Select Choice —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Primary Address for Trust Records (if different)

Initial Trustee (usually you) *

First

Last

Co-Trustee (optional)

First

Last

Successor Trustee #1 *

First

Last

Incapacity Instructions (during life). If you're incapacitated, how should funds be used? (check all that apply)

• Your health and long-term care
• Your education
• Your support & housing
• Your business continuity expenses
• Your maintain family lifestyle
• Your discretion of trustee as needed

Assets Included in the Trust: Which assets would you like to include? (check all that apply)

• Business & Investment Assets
• Real Estate
• Bank Accounts & Cash
• Personal Property & IP
• Retirement & Insurance

Disclosures & Acknowledgments *

• This intake is for information-gathering only and does not constitute legal or tax advice.
• I certify the information provided is accurate to the best of my knowledge.

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*NOTE* Completion of this form is for information – gathering only. It does not constitute a binding contract for service. Once we’ve received your intake form, we will contact you to schedule an initial consultation.