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1. How Old are you?
*
Under 18
18-24
25-34
35-44
45-60
61 or older
2. What is your currently monthly income from all your revenue streams?
*
Less than $1,000
$1,000 - $2,500
$2,500 - $5,000
$5,000 - $10,000
$10,000 - $25,000
Greater than $25,000
What is your relationship status?
*
Single
In a committed relationship or engaged
Married or domestic partnership
Other or I’d prefer not to say
4. Do you have children?
*
Yes
No
5. Do you have a Mortgage?
*
Yes
No
6. Do you set aside savings each month?
*
Yes
Only some months
No
7. Do you have an emergency fund of 3 months or more?
*
Yes
No
8. Do you carry a credit card balance or have personal loans that have an interest rate above 8%?
*
Yes
No
9. Do you keep more than two times your monthly expenses in your checking account?
*
Yes
No
10. Do you have any money in a savings account?
*
Yes
No
Not sure
11. How much interest per year do you earn in your savings account?
*
Under 0.10%
0.10 - 0.49%
0.50% - 0.99%
1.00% - or more
Not sure
Do you have any of the following types of investment accounts? Brokerage/taxable account, Individual retirement account (e.g. IRA, Roth IRA), Employer retirement account (e.g. 401(k) or 403(b))
*
Yes
No
13. Is your investment portfolio allocation in line with your risk tolerance and capacity?
*
Yes
No
Not sure
14. Do you hold any mutual funds or ETFs in your investment portfolio?
*
Yes
No
Not sure
15. Does your current employer offer a retirement savings account, for example, a 401(k)?
*
Yes
No
Not sure
16. Do you contribute to the retirement savings account?
*
Yes
No
Not sure
17. Does your employer have a program to match retirement contributions?
*
Yes
No
Not sure
18. Do you take full advantage of the retirement contribution match program?
*
Yes
No
Not sure
19. Do you have life and disability insurance policies in place?
*
Life Only
Disability Only
Yes
No
Only through my employer
Not sure
20. Do you have an estate plan in place including a will, a financial power of attorney, and an advance health care directive?
*
Yes
No
Some components
Not sure
21. For any future major expenses (for example, buying a home or having a child), have you identified the amount of money needed and over what timeframe?
*
Yes
No
I have a rough idea
22. Are you on track to meet your goals for future major expenses and retirement?
*
Yes
No
Not sure
23. How has your experience been with past Financial Advisors?
*
Great!
Ok
Terrible
I do it myself
24. If you were to pass before your spouse, my spouse would…
*
Need the help of a Financial Advisor
Handle our investments themselves
I don’t have a spouse
25. What is your zip code?
*
26. First & Last Name
*
27. Best Email (your advisor will send calculation data to this email)
*
28. Phone Number (an advisor will contact you regarding your free savings plan)
*
Phone
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