Contact Form

Whether you're planning for yourself and your family, or coordinating personal and business coverage, the more I know before we sit down, the more useful our first meeting will be. Nothing here is an application for insurance — it's just context.

Prefer to skip the form and contact me directly? Call/text me at 780-868-0552 or email ethan@marchandwealth.ca.

Personal Information

Full legal name*

Date of birth*

Sex*

Male Female

Phone* Email*

Preferred contact method

Phone Email Text

Best time to reach you

Morning Afternoon Evening

Business Information

Business name Your role / title

Business structure Years in operation

Number of employees

Do you have business partners?

Yes No

Current Coverage

Quick yes/no is fine — we'll go through details together.

Goals & Priorities

Select everything relevant — we'll prioritize together.

Tax-efficient wealth transfer Estate planning Business succession planning Key person protection Buy-sell agreement funding Retirement income planning Family income protection Debt / mortgage protection

Other goals

Health & Lifestyle

High level only — full detail happens during underwriting, not here.

Do you use tobacco or nicotine products?*

Yes No

Any high-risk activities? (aviation, motorsports, diving, etc.)

Yes No

Anything you'd like to flag before we speak? (optional)

Family & Beneficiaries

Marital status Number of dependents

Intended beneficiaries (names / relationship)

Additional Notes

Anything else you'd like me to know before we meet?