Name
*
Phone Number
Email
*
Age
*
18-24
25-34
35-44
45-54
55 or older
Are you currently retired, or planning for retirement?
*
Retired
Planning to retire in the next 1-5 years
Planning to retire in 6+ years
Have you purchased an annuity before?
*
Yes
No
What is your main retirement concern?
*
Running out of money
Protecting my savings
Growing my money safely
Leaving a legacy
Not sure
How much do you currently have saved or invested for retirement?
*
Under $50,000
$50,000 - $149,999
$150,000 - $499,999
$500,000+
Where are your Retirement Funds Currently Located?
*
Bank/CDs
401(k)/Employer Retirement Plan
Traditional or Roth IRA
Brokerage/Investment Account
Annuity
How long have you been looking for an annuity?
*
3-6 months
9+ months
I haven't started yet.
Your ad sparked my interest and I wanted to learn more.
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