Personal Planning Questionnaire

Section I: Services Requested

Section II: Contact Information (client and spouse)

CLIENT:
SPOUSE:

Section III: Beneficiary Information

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Section IV: Account Information

Account Type
Additional Account Information
529 College Savings, Custodial Account
Account Features (not applicable for all accounts)
SchwabOne Checks:
SchwabOne Visa Card:
eDelivery Enrollment:
eDelivery Email Preference:
Electronic Tax Payments:
MoneyLink (include “voided” check):

Section V: Estate Planning and Services

Section VI: Insurance Services

Coverage listed below is available through our affiliate, Valicenti Insurance Services, Inc.
  • Automobile
  • Homeowners
  • Life
  • Long-Term Care
  • Watercraft
  • Renters
  • Disability
  • Business
  • Recreational Vehicle(s)
  • Umbrella
  • Healthcare
Would you like an introduction?:

Section VII:

Tax Services
Business Services

Section VIII: Client Bill Paying Services

  • Establish a client checking account
  • Bills paid on the 10th and 20th of each month
  • Automatic transfers between your brokerage account and your checking account
  • Monthly reconciliation of bank statements
  • Quarterly reports mailed to you
Would you be interested in this service?:

Section IX: Other Financial Information

Section X: Other Financial Information (continued)

Any Significant Future Spending Plans?:
Any Significant Wealth Increase Anticipated?:
Gifting Plans?:
Special Needs Planning?:

Section XI: Investment Approach & Tolerance

Desired meeting frequency:
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Valicenti shall rely upon information provided by you on the PPQ, and will not verify the accuracy of any such information that you have provided. Accordingly, in the event that any such information provided is inaccurate or incomplete, the corresponding recommendations and/or conclusions could be inaccurate or incomplete. It remains your responsibility to notify Valicenti of any changes in the information provided.

Contact Info

Call Us: (607) 734-2665
Email: info@valicenti.com

400 East Water Street
Elmira, NY 14901

447 East Water Street
Elmira, NY 14901

24 West Market Street
Corning, NY 14830

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