Need a Financial Advisor?

In order for us to provide you with appropriate financial advice, we ask you to complete a basic questionnaire regarding your financial profile. This is not a complete questionnaire.  It will help us refer you to an appropriate advisor.

Disclaimer:

By giving my phone number I understand that I am giving permission for you to contact me and this waives my right to the National Do-Not-Call list whether my telephone number appears now or I subsequently add my telephone number(s) to the National or State list.

        What is your current household income from all sources?

less than $25,000                              $25,000 to $50,000
$50,000 to $100,000                        greater than $100,000

What is your investment objective?

Preservation of Capital            Income                 Growth
Speculation                              Tax Shelter           Other

        Are you currently invested or insured?   Please check all boxes that you have holdings.

Mutual Funds   Annuities  Life Insurance
Long Term Care Insurance  Stocks and/or Bonds
401k   403b    IRA                     
Other     If Other, describe:

        Do you have any specific need?


        Please provide the following contact information:

First name
Last name
Middle initial
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
E-mail

        Personal Information:

Date of birth
Sex Male Female

        Your Employer

Title
Organization

                            

Privacy Statement:

We are dedicated to serving our Customers’ needs for privacy as well as for creating products that they might find valuable. We do Not share our Customer’s non-public personal information with nonaffiliated companies except as otherwise permitted or required by law. We will not reveal our Customer information to any external organization unless we have previously informed our Customer in this or other disclosures or agreements, have been authorized by our Customer, or are otherwise required by law.

Last revised: May 25, 2004