“When you’re young you don’t need a lot of money, but when you are old you can’t survive without money, and a lot of it.” – TLR”

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Confidential Financial Questionnaire

Family Status:
Health Condition
Do you have the following?
Retired
Retired
Do you typically receive a tax refund?
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:
Other Income:
Checking + Low Risk – At Risk
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
Cash+ Low Risk – At Risk (copy)
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
Savings + Low Risk – At Risk
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
Money Mkt + Low Risk – At Risk
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
CD's + Low Risk – At Risk
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
Annuities + Low Risk – At Risk (copy)
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
Ret. Accts + Low Risk – At Risk
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
Pre. Metals + Low Risk – At Risk
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
Brokage Accts + Low Risk – At Risk
Assets (Circle + or – as your risk tolerance)
Enter the value $
Enter the value $
Enter the value $
Please circle your lookout toward taking risks with your money.
Risk Tolerance / Desires
Has your retirement account ever lost money due to market volatility or a market correction? How did it make you feel?
0= Not Concern 5 = Somewhat Nervous 10= Very Concern
If your account dropped 22% in one day as the DJ 30 did on October 19, 1987, how would you feel?
0= Not Concern 5 = Somewhat Nervous 10= Very Concern
How much can you afford to lose without the loss affecting your current lifestyle?
Do you now have your retirement account protected from loss?
Is your account protected from fees and commissions?
Suppose you could participate in some of the upswings of the market without ever having to worry about the negative effects of the market on your retirement account value. Would this be a major benefit to you?
Would you sleep better at night knowing you could never lose value again in your retirement account or any other account that you may own?
Which of the following are your top three concerns? (Pick only three)
After answering these questions, has your risk tolerance changed? (Circle Your Position)
Risk Tolerance / Desires
When You Retire, or if You Are Retired, Please Indicate the Priority of Your Withdrawals for Spending: Example: #1 Checking, #2 Social Security Income, #3 Your Qualified Accounts Give Ranking to the Following:
When You Retire, or if You Are Retired, Please Indicate the Priority of Your Withdrawals for Spending: Example: #1 Checking, #2 Social Security Income, #3 Your Qualified Accounts Give Ranking to the Following:
When You Retire, or if You Are Retired, Please Indicate the Priority of Your Withdrawals for Spending: Example: #1 Checking, #2 Social Security Income, #3 Your Qualified Accounts Give Ranking to the Following:
When You Retire, or if You Are Retired, Please Indicate the Priority of Your Withdrawals for Spending: Example: #1 Checking, #2 Social Security Income, #3 Your Qualified Accounts Give Ranking to the Following:
When You Retire, or if You Are Retired, Please Indicate the Priority of Your Withdrawals for Spending: Example: #1 Checking, #2 Social Security Income, #3 Your Qualified Accounts Give Ranking to the Following:
When You Retire, or if You Are Retired, Please Indicate the Priority of Your Withdrawals for Spending: Example: #1 Checking, #2 Social Security Income, #3 Your Qualified Accounts Give Ranking to the Following:
When You Retire, or if You Are Retired, Please Indicate the Priority of Your Withdrawals for Spending: Example: #1 Checking, #2 Social Security Income, #3 Your Qualified Accounts Give Ranking to the Following:
My job is to help you find the money that you now may now be giving away to others from your circle of wealth unknowingly and unnecessarily, to improve your monthly cash flow and your cash flow after you retire, and to seek better benefits for you and your family, helping you to adjust your risk profile to meet your comfort level. My mission is to accomplish all of this without you spending one more dime out of pocket than you are currently spending.