Please complete each question below then click the GREEN button to submit

Goals Questionnaire

Your Full Name *

Spouse's Full Name (if applicable)

Your Email *

Your Phone Number *

Can we text this number?

Yes

Your Date of Birth *

Your Home Address *

Is your home address the same as your mailing address? *

Yes

No (if no, please provide in additional comments section below)

Do you have children? If yes, list names and ages below

Your Employment Status (check all that apply)

Not Employed

Still Employed

Retired

If still working, projected Retirement Date?

Household gross monthly income

Household monthly expenses

Already receiving Social Security? *

Yes

If yes, what is the monthly amount?

Receiving or expect a pension? *

Yes

If yes, what is the monthly amount of your pension?

Type of Investments you currently own?

CD's, checking, savings account

Stocks, bonds, mutual funds (brokerage account)

Annuity

Which of the following describes your attitude towards your retirement assets? (check all that apply)

I do not want my retirement assets to decrease as a result of market fluctuation

I want the interest earned on my retirement assets to stay ahead of inflation

I want the potential for higher returns without the risk to principal and previously earned interest

I am willing to have a portion of my retirement assets exposed to fluctuations in the market for unlimited return potential

Paying for long term care is a concern for me

Yes

Not Sure

What would you consider reasonable interest earned on your retirement assets? (check all that apply)

1% - 3%

4% - 6%

7% - 9%

9% - 11%

Great than 11%

Anything else you want us to know for this meeting?

Please check the box below & click submit

I verify that all the information above is accurate to the best of my knowledge and understand that the information provided will be used by Plan Wise in the analysis process.

CONTACT INFO

FINANCIAL INFO

775-444-9335 / office@abshirefamilyfinancial.com