Fusco Insurance — Financial Goals, Protection & Retirement Review
Tell us what matters to you today and what you want your future to look like. We will review your goals, needs and priorities during a consultation. Powered by Legacy Wise Advisors.
Full Name
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First Name
Last Name
Email Address
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example@example.com
Phone Number
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Format: (000) 000-0000.
State
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Other/Outside US
ZIP Code
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Are you inquiring as an individual or on behalf of a business?
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Individual
Business
Business Name (if applicable)
Approximate Number of Employees (for group products)
What products or topics are you interested in? (Select all that apply)
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Life insurance
Individual disability or income protection
Group life
Short-term disability
Long-term disability
Voluntary employee benefits
Fixed annuities
Insurance-based retirement planning
Pension options
457(b)/403(b)/401(k)/IRA distribution and eligible rollover questions
Social Security/Medicare coordination
Financial preparedness / protection review
Employer retirement-plan provider coordination
Key-person life insurance
Buy-sell life insurance
Employer group dental
Other
What prompted you to review your financial preparedness now?
New job or income change
Move or home purchase
Marriage/divorce or family change
Retirement
Caregiving responsibility
Insurance change
Severe weather/emergency preparedness
Organizing important records and contacts
Other
Which areas would you like to review?
Insurance coverage/deductibles
Life insurance/beneficiaries
Important document organization
Property records
Emergency contacts
Estate/executor organization
Retirement/financial coordination
Not sure—help me identify gaps
Briefly describe your goals or questions
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Your Retirement Goals
Optional
What are your top three financial goals?
What concerns you most about your current financial position?
What would a successful consultation help you decide?
Retirement stage
Not ready to retire—preparing for the future
Within five years
Within twelve months
Already retired
Unsure
Employment category
Teacher/education
Federal government
State/local government
Private-sector
Self-employed
Retired
Other
Employer or pension system name
This review may consider tradeoffs, survivor income, insurance costs, and eligibility. There is no guaranteed increase in benefits, and there is no assumption that insurance should replace pension survivor benefits.
Estate Document & Family Readiness Interests
Documents are produced using attorney-drafted materials and attorney-approved legal rules through the independent provider’s review process. Individual attorney review occurs when required by that process. Legal services are provided separately by participating attorneys licensed in the applicable jurisdiction. Fusco Insurance and Legacy Wise Advisors are not law firms, do not draft legal documents or provide legal advice, and do not establish an attorney-client relationship with you. Pricing is provided after intake review and client qualification. Scope, available documents, provider requirements and any separate professional fees are confirmed before engagement.
Anticipated retirement month/year
Preferred contact method
Email
Phone
Either
Time zone
Which support would you like?
Pension payment/survivor options and pension maximization review
Protection of current/future income from disability
Family protection from premature death/life insurance
Existing policy review
Deferred compensation/eligible rollovers
Estate document coordination through the independent estate-document service provider
Funeral preplanning/final-expense questions
Request a separate tax-professional referral
Not sure
Do not submit SSNs, dates of birth, account numbers, balances, login details, tax returns or pension statements in this initial request. An appropriate collection process will be explained after review.
Current coverage or plan (optional)
Renewal or decision date (optional)
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What prompted this review now?
Please Select
Retirement within five years
Job change or retirement / old employer plan
CD maturity
Existing annuity or insurance contract review
No pension / retirement income gap
Inherited retirement account
Business or property sale / liquidity event
Social Security timing
Year-end retirement distribution / RMD
Annual age-55+ retirement income checkup
Market volatility / retirement-income concern
Other
When does this decision need attention?
Please Select
Within 30 days
30–60 days
60–120 days
Within 12 months
1–5 years
No specific deadline / planning ahead
What would be most useful from the review?
Retirement paycheck / income-gap review
Rollover alternatives review
CD or contract decision review
Cash/liquidity review
Social Security timing / bridge review
Inherited-account timeline
Liquidity-event proceeds planning
Year-end distribution checklist
Not sure — help me identify the right review
Other
Preferred contact time
Non-sensitive supporting materials only (optional)
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How did you hear about us?
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Google/Search
ChatGPT or another AI assistant
Facebook
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Nextdoor
Alignable
LinkedIn
Email
Text message
Event/Flyer/QR code
Existing customer
Friend or family
Business or professional referral
I've worked with Legacy Wise/Fusco before
Other
Who referred you, or please tell us more?
I agree to receive marketing emails (optional)
Yes, send me marketing emails
I agree to receive SMS messages (optional)
Yes, send me SMS messages
Important Notice:
Submitting this request does not establish coverage or an investment advisory engagement. Eligibility and product availability may vary by state and other factors. Securities are not offered. Please do not submit sensitive personal or financial information.
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