Full Name
*
Phone
*
Email
*
Zip Code
*
Male or Female
*
Male
Female
Married or Single?
*
Married
Single
When do you plan on retiring?
*
Now
Within the 1 year
Within 3-5 years
Within 10 years
What type of retirement plans are you investing in now:
*
Company 401(k) or 403(b)
Traditional IRA
ROTH IRA
None
What part of the guaranteed retirement account appeals to you most:
*
Guaranteed Income during retirement
ROTH conversions
Growth
Not Sure
Is your account protected from stock market crashes, declines, and fluctuations? (copy)
*
No
Yes
Not Sure
A rough estimate of how much you have saved for retirement:
*
Under $100,000
$100k - 250k
500k - $1 million
Greater than $1 million
Last question...
Do you have a 401(K) or 403(B) from a previous career:
*
Yes
No
