Legacy Wealth Planning - Law Offices of Bridget Mackay

Your Information

First Name *(Required)

Last Name(Required)

Marital Status(Required)

Married

Unmarried

Email Address(Required)

Date of Birth *

Client Gender

Spouse/Partner Information

Spouse/Partner’s First Name

Spouse/Partner’s Last Name

Spouse’s Email Address

Spouse/Partner’s Date of Birth

Spouse Gender

Physical Address

Physical address line 1

Physical address line 2

Physical address city

Physical State

State

Physical address zip/postal code

Is your Mailing Address the same as Physical Address?

My Mailing Address is the same

My Mailing Address is different. I'd like to enter that address

Mailing Address

Mailing address line 1

Mailing address line 2

Mailing address city

Mailing State

State

Mailing address zip/postal code

Phone Number 1

Phone Number 1 Description

Phone 1 number

Add A Second Number

Add Another Phone Number

Phone Number 2

Phone Number 2 Description

Phone 2 number

Add A Third Number

Add Another Phone Number

Phone Number 3

Phone Number 3 Description

Phone 3 number

How many children do you have, living or deceased?

If you have more than 4 children let us know during the personal consultation.

Child 1

Child 1 First Name

Child 1 Last Name

Child 1 Date of Birth

Child 1 Gender

Child 1 Email

Child 1 Phone

Child 1's Parent(s)

Child 1 Married?

Yes

No

Child 1's Children

Child 2

Child 2 First Name

Child 2 Last Name

Child 2 Date of Birth

Child 2 Gender

Child 2 Email

Child 2 Phone

Child 2's Parent(s)

Child 2 Married?

Yes

No

Child 2's Children

Child 3

Child 3 First Name

Child 3 Last Name

Child 3 Date of Birth

Child 3 Gender

Child 3 Email

Child 3 Phone

Child 3's Parent(s)

Child 3 Married?

Yes

No

Child 3's Children

Child 4

Child 4 First Name

Child 4 Last Name

Child 4 Date of Birth

Child 4 Gender

Child 4 Email

Child 4 Phone

Child 4's Parent(s)

Child 4 Married?

Yes

No

Child 4's Children

Additional Children Information

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