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401(k) WealthEngine Investment Profile


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Name:
Street Address:
City:
State:
Zip:
Email:
Best Contact#:
Best Time for Contact:
Married: Yes    No
If married, does your spouse work?: Yes    No
Expected retirement age:
Date of birth:
Expected sources of retirement income:
(Check all that apply) 		Social Security
401(K)
Other stock/bond investments
Real estate sales/rentals
Expected income from 401(k) at retirement:
Current value of 401(k) account:
Privacy Policy Disclosure
We are required by law to notify you of our policy concerning data we collect about you.

Categories of Information We Collect
We collect the following non-public information about you:
  • Information we receive from you on or in applications or other forms, correspondence, or conversations, including, but not limited to, your name, address, phone number, social security number, assets, income and date of birth; and
  • Information about your transactions with us, our affiliates, or others including, but not limited to your account number, balance, payment history, parties to transactions, cost basis information and other financial information.
Categories of Information We Disclose and Parties to Whom We Disclose
We do not disclose any non-public personal information about our current or former clients to nonaffiliated third parties, except as required or permitted by law.

Confidentiality and Security
We restrict access to your non-public personal information to those persons who require such information to provide products or services to you. We maintain physical, electronic and procedural safeguards that comply with federal standards to guard your non-public personal information.

Opt Out
No opt out list is maintained as we do not share or sell your information as indicated above.

If you have any questions concerning these policies, please call Dr. Arthur Jerry Minton. 513.621.9400 x11