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The Financial 4-PLAY Questionnaire
In order for us to provide you with our gold star experience, we need to get some information about you. This includes your goals once your credit is optimized.
17
Questions
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1
Name
*
This field is required.
First Name
Last Name
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2
Your Best Email
*
This field is required.
example@example.com
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3
Phone Number
*
This field is required.
Cell Phone Preferred
Please enter a valid phone number.
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4
What State Do You Live In?
*
This field is required.
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5
What Is/Are Your Goal(s)?
*
This field is required.
Check all that apply
Buy a new home
Buy a new car
Business Funding
Personal Funding
Become an investor
New Job/Career
Secure Your Retirement
Begin Building Wealth
Other
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6
In The Past 2 Years Have You Filed For Bankruptcy?
*
This field is required.
YES
NO
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7
Are You Currently Being Harassed By Creditors With Collection Calls?
*
This field is required.
YES
NO
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8
Have You Been A Victim Of Identity Theft?
*
This field is required.
YES
NO
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9
If Something We're To Happen To You, Would Your Family Be Able To Put Everything Together?
*
This field is required.
YES
NO
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10
Are You Interested In Learning How You Can Make Smart Investments & Putting Your Money To Work For You?
*
This field is required.
YES
NO
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11
How Important Is It To You To Build a Strong Credit File and To Have a Strong Financial Standing (Today and In The Future)?
*
This field is required.
Extremely Important
Somewhat Important
Not That Important
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12
When It Comes To Your Credit and/or Finances, What Concerns You The Most?
*
This field is required.
Don't be afraid to elaborate
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13
When it comes to restoring your credit and/or improving your finances, what are your expectations for this process?
*
This field is required.
Explain what are your realistic expectations from us or any company you employ to help you reach your goals
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14
How Did You Learn About Our Services
*
This field is required.
Facebook
Instagram
TikTok
Referred by Friend or Family Member
Postcard Mailer
Google Search
Email Message
Outside Signage
Other
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15
Are You Working With An Agent?
*
This field is required.
If you are working with one of our agents, select their name from the list below:
No I Am Not
Ray Medlin
Meredith Alexander
Ray Smith
Michael Mills
Tommie Gaines
Latasha Risher
Kimberly Snowden
Monique Macklin
No I Am Not
Ray Medlin
Meredith Alexander
Ray Smith
Michael Mills
Tommie Gaines
Latasha Risher
Kimberly Snowden
Monique Macklin
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16
You are aware that the monthly membership for the Financial 4-PLAY program is $69.69. Your first month is for only $69.69 which is your registration/setup fee?
*
This field is required.
Yes
No
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17
One Of The Requirements For The Membership Is To Refer At Least One Person Who Can Benefit From Changing Their Financial Life. Do You Have At Least One Person You'd Like To Empower Through Our Program?
In the box provide the name of the person
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