COMPLEMENTARY FINANCIAL EVALUATION
(Confidential) Fill out the form carefully for proper follow up
Today’s Date
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Month
-
Day
Year
Date
How Do You Spell Your Name?
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email Address
example@example.com
Would you consider it to be ________ to provide financial security for your financial future:
*
Unimportant
Important
Extremely Important
Do you have an updated will/trust?
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Yes
No
Do you currently have life insurance?
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Yes
No
If we can save you money on your policy, and/or give you a free upgrade, would that be something you would be open to?
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Yes
No
If you qualify for the upgrade:
*
would you prefer paying the same and getting more coverage
staying with the same coverage and paying less
Does your company provide you with a retirement plan?
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Yes
No
If Yes, What Kind?
401K,403B,457 ect..
Are you currently participating in it?
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Yes
No
Are you contributing to any retirement plans outside of work?
Yes
No
If we lower your fees to your retirement plan, would that be something you would be open to?
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Yes
No
Do you already have a Financial Advisor?
Yes
No
Are you open to a 2nd Opinion if it would improve your Financial Strategy?
Yes
No
Outside of tomorrow, at what age would you like to retire?
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When will money work for you, so you no longer work for money
What is your current age?
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When will money work for you, so you no longer work for money
How much money do you think you would need per month to retire comfortably, and stay retired?
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When will money work for you, so you no longer work for money
Are you on track to reach that goal?
Yes
No
Unknown
If we, can show you a surefire way to be on track, would you be open to it?
Yes
No
If we could improve your financial situation, which of the following would you like to learn more about? Please Check all That Apply
*
Life Insurance/Protection For My Family
Personal Pension Plan
401k/IRA Rollover
Emergency Fund
College Education Funds
Estate/Legacy Planning
Free Personal/Business Financial CheckUp
How to Help & Educate My Family/Friends
Earn More Income
What Day & Time Can We Contact You To Schedule A Financial Check Up?
*
(Date & Time, Location, Within 24-48 Hrs.) Office, Home, Other
Submit
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