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                        Parish & Company LLC
                                             Client Information Summary

 
Name                                                             Date of Birth

______________________________                     __________________

______________________________                     __________________

______________________________                     __________________

______________________________                     __________________

______________________________                     __________________


Please include children's and spouses information, if applicable.  Also include
information of any non-family member you wish to designate as an IRA beneficiary.

Name of Account Holder (1) :  ____________________________________________

Home Street Address  ______________________________________________________________

City _________________________  State  ___________________   Zip  _____________________

Home Phone___________________   Home Fax ________________  Email  __________________

Driver's License#  _______________  Expiration:   _________________  State  ________________

Employer Name and Occupation  ______________________________________    Years ____

Employer Street Address ____________________________________________________________

City  _______________________________  State  ________________  Zip  __________________

Work Phone  ______________  Work Fax  ____________________  Email   __________________

401k/403B Investment Firm   ______________________    Balance in Plan   __________________


Name of Account Holder (2) :  ____________________________________________

Home Street Address  ______________________________________________________________

City _________________________  State  ___________________   Zip  _____________________

Home Phone___________________   Home Fax ________________  Email  __________________

Driver's License#  _______________  Expiration:   _________________  State  ________________

Employer Name and Occupation  ______________________________________    Years ____

Employer Street Address ____________________________________________________________

City  _______________________________  State  ________________  Zip  __________________

Work Phone  ______________  Work Fax  ____________________  Email   __________________

401k/403B Investment Firm   ______________________    Balance in Plan   ___________________


Other Key Advisors:

Accountant  ________________      Firm Name ___________________  Email _________________

Attorney      ________________      Firm Name ___________________  Email  __________________

Do You Have a Will/Trust Prepared?  _____________

Bank /Credit Union ( Checking and Savings)  ___________________________________________

Cash Reserve Amount on Hand (Savings for Unexpected Needs)  _____________


Current Investment Accounts Maintained at the Following Firms:
(Please also provide recent statement copy for each account)

Firm ____________________  Advisor Name _____________________ Amount  _____________

Firm ____________________  Advisor Name _____________________ Amount  _____________

Firm ____________________  Advisor Name _____________________ Amount  _____________

Firm ____________________  Advisor Name _____________________ Amount  _____________


Summary of Income and Investments:

Total Net Worth and Liquid Net Worth        _______________      __________________      

Annual Income                                              _______________

Annual Savings                                              _______________

Approximate Value of Home        ____________           Loans Outstanding     _________________

Other Real Estate Mkt Value        ____________            Loans Outstanding     _________________

Other Investments Including Partnerships, etc.     __________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Retirement Goals:

Planned Retirement Date   _________________________    

Expected Annual Income Necessary if You Retired Now (Today)   _______________


Overall Financial Goals:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Note:  Please do not email this information but rather fax to 503-747-2495
or send via traditional mail.

                                          Parish & Company
                                    4800 Meadows Road  Suite 300

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