FINANCE 101 Personal Finance Strategy Survey

Date

MonthDayYear

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Phone Number

Area CodePhone Number

Are You:

Personal Challenges:

1. Are you suffering from financial losses as a result of the recent economic downturn?*

YesNo

2. Are you concerned about any of the following?

Too many bills or debts?*

YesNo

Lack of savings or investments for retirement?*

YesNo

Lack of preparation for your kids’ college education?*

YesNo

Not having enough protection in case of disability, long term illness or even death?*

YesNo

3. Do you carry any significant financial responsibilities with growing children or aging parents?*

YesNo

4. Are you concerned about the future of your job or career?*

YesNo

5. Do you feel that financial terms such as investments, insurance, debt, inflation and tax are difficult to understand?*

YesNo

6. If you were to choose, what would you rather have?*

Better RETURN for your moneyBetter SAFETY for your money

7. What is your ideal retirement age?*

8. Do you want to learn how to get your children into a good college with proper funding?*

YesNo

9. Do you want to learn more about how money works and how to build a proper financial future?*

YesNo

10. Are you interested in making more money on a part-time basis?*

YesNo

11. Do you want to explore a new business career in the fast-growing financial industry?*

YesNo