Wealth Accumulation Survey

This survey helps us determine how we can best serve your financial needs!
Enter Your First Name:
Enter Your Last Name:
Enter Email Address:
Enter Your Phone Number:
Best Time To Call:  :     AM   PM
Which type of retirement savings do you own? (check all that apply):
 401K  403B  Annuities
 CD's  Deferred Compensation  IRA/SEP
 Mutual Funds  Pension  Stocks/Bonds
 TSP  Other  None
Have you lost money in the stock market in the past five years?  Yes   No
Can you afford to lose any money?  Yes   No
Would you like to watch your retirement GROW with guarantees?  Yes   No
Did you know that you can retire tax free? (Ask about the Roth/IRA  Yes   No
Would you transfer a portion of what you already save to get a higher return on your money?  Yes   No
Do you currently have life insurance coverage that is not provided by your employer?  Yes   No
If we could show you how to make a GUARANTEED rate of return on your money, would you be interested?  Yes   No
In case of accident, sickness or injury, would you be interested in receiving cash for your daily living expenses?  Yes   No
Would you like a Benefits Counselor to show you a better way to save?  Yes   No



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