AIS Financial Appraisal Form

If you would prefer, you may download a copy of this form and mail it to us. Asterisks (*) indicate required fields.

Date
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GENERAL INFORMATION
I am applying for: (check all that apply)(*)

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Name(*)
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Street or Box(*)
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City(*)
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State(*)
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Zip Code(*)
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Home Phone(*)
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Business Phone
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Email(*)
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Your D.O.B.(*)
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Spouse's D.O.B.
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Your Occupation(*)
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Spouse's Occupation
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Do you or your spouse face any serious health problems?(*)

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Please list the ages of your children or other dependents.
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Please provide a brief statement of your investment objectives:(*)
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Risk Tolerance:(*)

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Total Annual Outlays(*)
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Total Annual Income(*)
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Annual Savings (+ or -) Equals Annual Income less Annual Outlays(*)
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Additional Information
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ASSETS AND LIABILITIES SUMMARY
Investment Portfolio (Use this section for assets not listed on your brokerage statements)
Cash on Hand (including checking accounts)
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Savings Accounts
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Money Market Funds
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Bank Certificates of Deposit
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U.S. Treasury Bills
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Bullion and/or Coins
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Cash Value Life Insurance/Annuities
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Other Bonds
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Preferred Stocks
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Common Stocks
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Mutual Funds
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Total Investment Portfolio
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Other Assets
Private Notes and Mortgages Held
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Value of Residence
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Less Mortgage Amount
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Equity (subtract mortgage balance from value)
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Value of Income Property
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Less Mortgage Amount
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Equity: (subtract mortgage balance from Value)
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Equity in Private Business(es)
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Other Assets
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Total Other Assets
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Debts Other than Mortgages
Please list all your other debts other than mortgages
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Total Nonmortgage Debt
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Preferred Custodian (if any)(*)

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Please indicate the amount in cash and/or securities you plan to deposit in the account. (The combined minimum is $100,000 for PAM and HYD, and $50,000 per single account for PAS)(*)
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Provide specific instructions/restrictions,
if any, concerning management of your account(s)
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Attach copy of your
current financial statement
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