| Company Name |
|
| First Name |
|
| Last Name |
|
| Address Line 1 |
|
| Address Line 2 |
|
| City |
|
| State |
|
| Zip |
- |
| Daytime Phone Number |
- - |
| Evening Phone Number |
- - |
| Fax Number |
- - |
| Email Address |
|
| Occupation |
|
| Date of Birth |
|
| Annual Earnings |
$ |
| Do you currently participate in or maintain a retirement plan? YES NO |
| If yes, identify the type(s) of Plan(s) and their estimated level of assets. |
|
| Current Contribution Per Year |
$ |
| How many individuals are employed by your business? |
| What is the name of your business? |
| How is it structured (sole proprietorship, corporation, etc.)? |
| My spouse is employed by me.
YES
NO |
| My spouse is employed at |
| My spouse participates in a plan at work. YES NO |
| My spouse's type of plan is |
Please enter a rating of 1-5 for each item below based on the following scale
1=Strongly Disagree 2=Mildly Disagree 3=Neutral 4=Somewhat Agree 5=Strongly Agree |
| I
want to maximize retirement benefits for owners/key employees. |
-
1
2
3
4
5 + |
| I
want to maximize my tax deduction. |
-
1
2
3
4
5 + |
| I
want to allow employees to save for their retirement. |
-
1
2
3
4
5 + |
| I
would offer a matching employer contribution to help employees
save for their retirement. |
-
1
2
3
4
5 + |
| Employees
generally have long service with our organization. |
-
1
2
3
4
5 + |
| I
can generally produce better investment results than a professional
advisor. |
-
1
2
3
4
5 + |
| I
need a better understanding of what I will have to live on at
retirement. |
-
1
2
3
4
5 + |
|
If I could, I would like to deduct from my taxes: |
$10,000
$30,000
over $30,000 |
| I
would like to retire in: |
10Yrs.
20Yrs.
Age 65
Age
|
| The
best time to phone me for the initial consultation is: |
|
| An
alternate time to phone me for the initial consultation is: |
|
|
|
