PRENUPTIAL INTAKE Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth Future Spouse's Name First Name Last Name Future Spouse's Phone (###) ### #### Future Spouse's Current Address Address 1 Address 2 City State/Province Zip/Postal Code Country Future Spouse's Date of Birth MM DD YYYY Date of Proposed Marriage Approximate MM DD YYYY Your Employer name, phone, and address Spouse's employer name, phone, and address Are there any premarital children? If so, please provide Name, Date of Birth, and Residence of each minor child Do you have health insurance? Is so, name of carrier and policy number Real Property # 1: address, year bought, market value, and current amount you owe Real Property # 2: address, year bought, market value, and current amount you owe Real Property # 3: address, year bought, market value, and current amount you owe Real Property # 4: address, year bought, market value, and current amount you owe Name of Bank Accounts, Savings Accounts, C.D.’s, Credit Union, Savings Bonds: Account #1 (provide last 4 digits of each account) Name of Bank Accounts, Savings Accounts, C.D.’s, Credit Union, Savings Bonds: Account #2 (provide last 4 digits of each account) Name of Bank Accounts, Savings Accounts, C.D.’s, Credit Union, Savings Bonds: Account #3 (provide last 4 digits of each account) Name of Bank Accounts, Savings Accounts, C.D.’s, Credit Union, Savings Bonds: Account #4 (provide last 4 digits of each account) Name of Bank Accounts, Savings Accounts, C.D.’s, Credit Union, Savings Bonds: Account #5 (provide last 4 digits of each account) Name of Bank Accounts, Savings Accounts, C.D.’s, Credit Union, Savings Bonds: Account #6 (provide last 4 digits of each account) Name of Bank Accounts, Savings Accounts, C.D.’s, Credit Union, Savings Bonds: Account #7 (provide last 4 digits of each account) Credit Card # 1: Name, balance, and last 4 digits Credit Card # 2: Name, balance, and last 4 digits Credit Card # 3: Name, balance, and last 4 digits Credit Card # 4: Name, balance, and last 4 digits Credit Card # 5: Name, balance, and last 4 digits Motor Vehicle, Boat, Airplane, Motorcycle, Trailer # 1 (Year, make, and model) Motor Vehicle, Boat, Airplane, Motorcycle, Trailer # 2 (Year, make, and model) Motor Vehicle, Boat, Airplane, Motorcycle, Trailer # 3 (Year, make, and model) Motor Vehicle, Boat, Airplane, Motorcycle, Trailer # 4 (Year, make, and model) List of all pensions, 401k, and/or retirement plans Please provide the carrier and last four digits of the account number for each: Debt # 1 other than credit card (mortgage, car loan, student loan, other loans or judgments) Debt # 2 other than credit card (mortgage, car loan, student loan, other loans or judgments) Debt # 3 other than credit card (mortgage, car loan, student loan, other loans or judgments) Debt # 4 other than credit card (mortgage, car loan, student loan, other loans or judgments) Debt # 5 other than credit card (mortgage, car loan, student loan, other loans or judgments) Stocks, Investments, and Securities Please provide information of all stocks, investments, and securities. This includes business expenses. What is your main objective in getting a prenuptial agreemnt? Are you planning on having children with your future spouse? If so, when and how many? Do you wish to waive spousal support? What type of custody arrangement would you prefer in the event that you have a child with your future spouse and then separate? Do you want restrictions on where children can live in the event of separation? Thank you!
