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Changemakers Financial | Assessment Form
And we'll find your trusted responsible investment advisor!
14
Questions
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1
When would you like to retire?
*
This field is required.
1-4 years
5-9 years
10-19 years
20-29 years
30 + years
I'm already retired
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2
How confident are you in your long-term financial plan?
*
This field is required.
Very confident
Somewhat confident
Not confident
I don't have a plan
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3
Where do you expect the majority of your income to come from?
*
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Investments
Employer
Business
Government
Other
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4
How do you currently manage your money?
*
This field is required.
I manage my own investments
I use retirement plans
I use a robo-advisor
I work with a financial planner
I don't manage my money
Other
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5
Are you married?
*
This field is required.
Yes
No
Prefer not to say
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6
Do you own your home?
*
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Yes
No
Other
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7
Do you need financial advice for any of the following?
*
This field is required.
Please select all that apply
Investments
Taxes
Insurance
Real Estate
Estate Planning
Business advice
Success Planning
Other
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8
Where do you prefer your advisor to be located?
*
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Local (You'll work with an advisor near you)
National (More choices by teleconference)
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9
Please estimate your household income
*
This field is required.
This allows your advisor to develop a custom plan for you
Less than $39,999
$40,000 to $74,999
$75,000 to $99,999
$100,000 to $149,999
$150,000 to $249,999
Over $250,000
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10
Tell which city you currently reside in
*
This field is required.
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11
Please estimate your total investable assets
*
This field is required.
This allows your advisor to develop a custom plan for you
Less than $24,999
$25,000 to $99,999
$100,000 to $249,999
$250,000 to $999,999
$1,000,000 to $4,999,999
Over $5,000,000
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12
What's your name?
*
This field is required.
Your information is kept confidential.
First Name
Last Name
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13
What's the best number for your advisor to call?
*
This field is required.
Please enter a valid phone number.
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14
Where can we send your advisor's contact information?
*
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example@example.com
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15
Lead Source
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