Wealthnet CRT Proposal Request Form

Charitable Remainder Trust
Proposal Request Form

Proposal Type: [required]
Summary Page Fax (Faxed one page summary used for determining feasibility)
Summary Page Mail (Mailed one page summary used for determining feasibility)
Full Proposal (for Client Presentation Mailed within 2 working days)

DONOR INFORMATION
Name: [required]
Birthdate: (1/1/1940) [required]
Spouse's Name:
Birthdate: (1/1/1940)
Federal Income Tax Bracket % : % (Max 39.6%) [required]
State Income Tax Bracket % : % (Donors State) [required]
Estate Tax Bracket % : % (Max 55%) [required]
Current Annual Income $: [required]

ASSET INFORMATION
Asset Type : [required]
Market Value of Asset $: [required]
Cost Basis of Asset $: [required]
Debt on Asset $:
Net Cash flow from Asset $: [required]
Number of Years Held :

TRUST INFORMATION
Type of Trust:
Payout Rate on Illustration % : % (Min 5%)
Payout Frequency :
Portfolio Rate of Return % : %
Income Deferral Period : Years (NIMCRUT ONLY!)

ADVISOR INFORMATION
Name: [required]
Email: (your@emailaddress) [required]
Firm:
Address:

Phone: [required]
Fax:
How did you hear about us?
Reference:

Comments:


Proposal Contact Home	Charitable Remainder Trust Proposal Request Form Proposal Type: [required] Summary Page Fax (Faxed one page summary used for determining feasibility) Summary Page Mail (Mailed one page summary used for determining feasibility) Full Proposal (for Client Presentation Mailed within 2 working days) DONOR INFORMATION Name: [required] Birthdate: (1/1/1940) [required] Spouse's Name: Birthdate: (1/1/1940) Federal Income Tax Bracket % : % (Max 39.6%) [required] State Income Tax Bracket % : % (Donors State) [required] Estate Tax Bracket % : % (Max 55%) [required] Current Annual Income $: [required] ASSET INFORMATION Asset Type : [required] Market Value of Asset $: [required] Cost Basis of Asset $: [required] Debt on Asset $: Net Cash flow from Asset $: [required] Number of Years Held : TRUST INFORMATION Type of Trust: Payout Rate on Illustration % : % (Min 5%) Payout Frequency : Portfolio Rate of Return % : % Income Deferral Period : Years (NIMCRUT ONLY!) ADVISOR INFORMATION Name: [required] Email: (your@emailaddress) [required] Firm: Address: Phone: [required] Fax: How did you hear about us? Reference: Comments: