Financial Fitness
Are You Financially Fit? Find Out!
FinancialFitness4u.com
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What are your 2 Biggest financial goals/concerns right now?
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Saving More
College Funding
New Home
Student Loans
Next Mortgage / Rent Payment
Retirement
Long Term Care
Legacy Planning
Next Vacation
Holiday Shopping
Home Improvements
Child Care
Other
An age old question, when it comes to a home, is it better to rent or to buy?
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Buy
Rent
Do you have a work sponsored retirement Plan (i.e. SEP IRA, 401(k), 403(b), 457, etc.)? and If so, do you participate in it?
Yes I have one and Yes I participate in it.
Yes I have one and No, I do not participate in it.
No I do not have a work sponsored Retirement Plan.
Do you have a work sponsored retirement Plan (i.e. SEP IRA, 401(k), 403(b), 457, etc.)? and If so, do you participate in it?
Please Select
Yes I have one and Yes I participate in it.
Yes I have one and No I do not participate in it.
No I do not have a work sponsored Retirement Plan.
If you Do Participate in a Work Sponsored retirement plan, does your employer match?
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Yes
No
If you do participate and your employer does match, what % is matched?
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Please Select
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
What is the approximate value of your retirement accounts?
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What is the approximate value of your retirement accounts?
*
Please Select
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
Do you have financial planning outside of your "work benefits"?
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Yes
No
How much of your household income do you annually save (include your IRA or 401(k) and employer match)?
*
Please Select
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
11%
12%
13%
14%
15%
16%
17%
18%
19%
20%
If you could start all over again, in the 1st stage of your new wealth building plan design, which option would you choose to include in your plan, would you want your wealth to be:
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Taxed
Tax Free
If you could start all over again, in the 1st stage of your new wealth building plan design, which option would you choose to include in your plan, would you want your wealth to be:
Please Select
Taxed
Tax Free
In the 2nd stage of your wealth building plan design would you prefer to have gains that are:
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Slow & Steady with consistent and potentially smaller returns
Volatile ups and downs with potentially larger returns
In the 2nd stage of your wealth building plan design would you prefer to have gains that are:
Please Select
Slow & Steady with consistent and potentially smaller returns
Volatile ups and downs with potentially larger returns
Do you adhere to a strict monthly budget for your perosonal finances?
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Yes
No
I would like to explore ideas to minimize taxes.
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Yes
No
I think taxes are definitely going up in the future.
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Yes
No
I would like to explore ideas on how to save more money each year.
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Yes
No
I currently have debt (credit cards, auto loans, student loans, Not Your Mortgage):
Please Select
None
Small Amount (i.e. less than $5,000)
Some (i.e. less than $20,000)
More than I want (i.e. up to $50,000)
Way Too Much (i.e. more than $50,000)
If you knew you were about to suddenly die, would you financially worry about your spouse and/or children?
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Yes
No
Is planning for the future very important to you?
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Yes
No
Do you feel you can leave your family too much life insurance?
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Yes
No
Would you have difficulty coming up with $1,000 cash for an emergency?
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Yes
No
Do you feel that the purchase of life insurance is?
*
Please Select
A Wise Choice
A Waste of Money
If you were to pass away today, are you confident your family would have the “Final Expense Funds” available within 2 or 3 business days of your death?
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Yes
No
If you are a home owner, what is the approx. value of your home?
*
Please Select
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
>$1,000,000
Very Approximate Annual Household Income:
*
Please Select
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
Your Age
*
Please Select
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Marriage Status
*
Please Select
Single
Maried
Divorced
Widowed
Do you have children?
*
Please Select
Yes
No
We plan on having one soon
If Yes, how many children do you have?
*
Please Select
1
2
3
4
5
6
What is the age of your 1st Child?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
What is the age of your 2nd Child?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
What is the age of your 3rd Child?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
What is the age of your 4th Child?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
What is the age of your 5th Child?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
What is the age of your 6th Child?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Have you begun Saving for their College Tuition?
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Yes
No
Your Financial Fitness
*
Please Select
Do you feel satisfied with your situation?
Do you want to improve your situation?
Do you feel improving your situation is too hard?
First Name
*
Your Email
*
Phone (Optional)
Submit
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