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Wealth Accelerator Intake Form

We kindly request that you fill out the following assessment. It's important to provide responses that are as candid and transparent as you can be. The information you share will be instrumental in crafting an optimal plan tailored to your success this year.

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Question 1 of 18

What is your Instagram Handle?

Question 2 of 18

Which Country are you currently living in?

Question 3 of 18

What is your age bracket? 

A

20-24

B

25-29

C

30-34

D

35-39

E

40-44

F

45-49

G

50-54

H

55+

Question 4 of 18

What is your average yearly income? 

A

$10k-$20k

B

$20-$40k

C

$40k-$60k

D

$60k-$80k

E

$80k-$100k

F

$100k-$250k

G

$250k-$500k,

H

$500k-$1 mil

I

$1 mil+

Question 5 of 18

What type of streams of income do you currently have? (List them all and the current balances)

Question 6 of 18

What is your money goal and why?

Question 7 of 18

What will be your reward when you achieve your money goal? 

Question 8 of 18

Think back over the past 12 months. What highlights stand out to you?

Question 9 of 18

What were the hardest experiences of the past years of your life?

Question 10 of 18

What do you think is keeping you from building wealth? (check all that apply)

(Select all that apply)
A

Drowning in Debt

B

Not being able to stick to a plan

C

Not understanding financial concepts

D

Overspending and/or underearning

E

Not being aligned with my priorities and values

F

Unexpected expenses, Inflation, Getting laid off

G

Not having enough streams of income

Question 11 of 18

Where do you see yourself in the next 12 months? 

Question 12 of 18

What are you willing to do to get you there? 

Question 13 of 18

What difference will that make in your life and the life of your loved ones?

Question 14 of 18

Are you committed and open to do what it takes to reach your goals?

A

Yes

B

No

Question 15 of 18

On the Scale of 1-10, 10 being the highest, how open are you to investing in yourself and your financial future? 

A

1

B

2

C

3

D

4

E

5

F

6

G

7

H

8

I

9

J

10

Question 16 of 18

If, after our conversation, you know that this is a better plan than what you have right now, are you willing to commit to the plan?

(Select all that apply)
A

Yes

B

No

Question 17 of 18

Which Payment Option do your prefer? 

A

Pay in Full (best investment option)

B

Make Payments

Question 18 of 18

Any additional comments or questions you have...

Confirm and Submit