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Type
Info
Profile
Statement
Profile
& Contacts
& Sign
Account Type
Please select the type of account(s) you wish to establish. Information provided may be used for multiple accounts under the same Tax ID or household with identical information.
* Required fields
Account Holder Information
Please provide accurate personal information for all account holders. All accounts must be opened with a physical address.
* Required fields
Please upload clear, legible copies of your government-issued identification. Files must be JPG, PNG, or PDF, max 10MB each.
JPG, PNG, PDF — max 10MB
JPG, PNG, PDF — max 10MB
JPG, PNG, PDF — max 10MB
JPG, PNG, PDF — max 10MB
Please upload the documents related to your relinquished property. If documents are not yet available, you can save your progress and return to upload them later.
PDF preferred — max 10MB
PDF preferred — max 10MB
Please provide details about the property you are selling. This information helps us identify the right replacement properties and calculate your exchange requirements. Estimated figures are acceptable if the sale is not yet final.
Please provide the contact information for the Qualified Intermediary holding your exchange proceeds. If you have not yet selected a QI, you can save and return to complete this section later.
Income & Financial Profile
Complete your source of funds and investment experience below — your net worth figures are calculated automatically in the Net Worth Statement (Section 4).
Enter approximate current value of existing holdings and indicate your prior experience with each investment type.
| Investment Type | Prior Experience? | # of Years |
|---|---|---|
| 1031 Exchange | ||
| Equities | ||
| DSTs (Delaware Statutory Trusts) | ||
| Fixed Income / Bonds | ||
| DPP / NT-REITs | ||
| Fixed Insurance | ||
| Investment Companies (Mutual Funds, ETFs) | ||
| Investment Real Estate | ||
| Options | ||
| Variable Products (Annuities / VUL) |
Statement of Net Worth
Enter your asset and income figures below. All totals — including Total Net Worth, Liquid Net Worth, and Annual Income — are calculated automatically and will carry forward to your financial profile.
| Asset Type | Approximate Value |
|---|---|
| Cash / Money Markets / CDs (Bank) | |
| Brokerage (Non-Managed) | |
| Managed Accounts | |
| Mutual Funds (Direct) | |
| Annuities (Fixed, Fixed-Indexed, Variable) | |
| Cash Value of Life Insurance | |
| Other (Business Assets, Collectibles, etc.) | |
| Trust | |
| Subtotal — Liquid Non-Qualified | $0 |
| Asset Type | Approximate Value |
|---|---|
| Cash / Money Markets / CDs (Bank) | |
| Retirement Plans (401K, 403B, 457, etc.) | |
| Brokerage (Non-Managed) | |
| Managed Accounts | |
| Mutual Funds (Direct) | |
| Annuities (Fixed, Fixed-Indexed, Variable) | |
| Subtotal — Liquid Qualified | $0 |
| Asset Type | Purchase / Estimated Value |
|---|---|
|
Primary Residence
⚠ Not counted toward net worth — for reference only
|
|
| Investment Real Estate (excl. primary residence) | |
| Subtotal — Illiquid Real Estate (excl. primary) | $0 |
List all current holdings and proposed investments. Assets to be exchanged should be listed as "Current" or "Recommended." If a DPP, NT-REIT, or DST investment is being made, applicable disclosure forms will also be required.
| Investment Name | Purchase Amount | Current or Recommended | |
|---|---|---|---|
| Subtotal — Illiquid Investments | $0 | ||
Include any qualified plan assets that are restricted, in a lockup, or subject to substantial early withdrawal penalties.
| Investment Name | Purchase Amount | Current or Recommended | |
|---|---|---|---|
| Subtotal — Illiquid Qualified | $0 | ||
| Liability Type | Amount |
|---|---|
|
Mortgage — Primary Residence
Only enter the amount by which the mortgage exceeds the fair market value, if any
|
|
| Mortgages — Secondary or Investment Real Estate | |
| Home Equity Loans / Auto Loans / Student Loans | |
| Credit Card Balances & Unsecured Loans | |
| Other Liabilities | |
| Total Liabilities | $0 |
| Income Source | Annual Amount |
|---|---|
| Salary / Commissions | |
| Investment Income (Interest & Dividends) | |
| Pension | |
| Social Security | |
| Net Rental Income (Investment Property) | |
| Total Annual Income | $0 |
| Estimated Annual Expenses | |
| Discretionary Income (Income − Expenses) | $0 |
| Category | Amount |
|---|---|
| Assets | |
| Liquid Non-Qualified Assets | $0 |
| Liquid Qualified Assets | $0 |
| Illiquid Real Estate (excl. primary residence) | $0 |
| Illiquid Non-Qualified Investments (1031 / DST) | $0 |
| Illiquid Qualified Assets | $0 |
| Total Assets (excl. primary residence) | $0 |
| Liabilities | |
| Total Liabilities | $0 |
| = Total Net Worth | $0 |
| Net Worth Breakdown | |
| Total Liquid Net Worth | $0 |
| Total Illiquid Securities | $0 |
| Illiquid as % of Total Assets | 0% |
| Income | |
| Total Annual Income | $0 |
| Estimated Annual Expenses | $0 |
| Discretionary Income | $0 |
2 Liquid assets must be readily marketable with no or low charge/penalty for inclusion.
Securities offered through Concorde Investment Services, LLC Member FINRA/SIPC. Advisory services through Concorde Asset Management, LLC, SEC Registered Investment Adviser. Insurance products through Concorde Insurance Agency, Inc.
Investment Profile
Please provide your investment objectives, risk tolerance, time horizon, and strategy. This information helps us ensure recommendations are appropriate for you.
Disclosures & Contacts
Required disclosures and contact designations for your account.
You authorize us to contact this person (must be 18+) to address possible financial exploitation, confirm your contact information, or health status, as permitted by FINRA Rule 2165. This person cannot trade or access your account.
Please send duplicate copies of Concorde communications to the person listed below. If an email is indicated, duplicate copies will be sent via email. Note: Concorde is not a custodian of any accounts — your authority to provide duplicate copies does not apply to account statements. Customers must separately elect duplication of account statements directly with custodians/vendors.
Review & Signature
Please review your information and provide your signature to complete this application.
By signing this Application, you affirm that:
You have received and read this Application and any supplemental documents, including Form CRS. You affirm that the information you have provided is accurate, including but not limited to your annual income, total net worth, liquid assets, source of funds, investment objectives, liquidity needs, time horizon, and Trusted Contact. You agree to notify us of any changes in the information provided.
You understand that investing involves risk and that different products involve different degrees of risk. The information provided will be used to determine investment suitability.
Note: Submission of this form does not constitute account opening. Your registered representative will review the completed information and contact you to finalize the account setup and provide Form CRS.
Application Submitted
Thank you for completing your client intake form. A member of the Diversified 1031 team will review your information and contact you within one business day to finalize your account setup.
If you have questions, please contact us at diversified1031.com
