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Life Insurance Questionnaire
To help us serve you better, please take a little time to tell us about yourself and the financial solutions you are interested in addressing.
If you have any questions call Matthew Richey 253-569-1495
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* Indicates required question
Email
*
Your email
First and last name
*
Your answer
Phone number
*
Your answer
What is your gender?
*
Female
Male
When were you born?
*
MM
/
DD
/
YYYY
What does your current financial situation look like?
*
Choose
I'm in a good place.
I'm in a decent place, but worry about the short-run or long-term
Not good
Do a lot of people depend on you?
Choose
Yes, and I'd like to be able to take care of them if need be
They do now, but it's not long-term situation.
Yes, and I'm not sure what to do about the long-term if something were to happen to me.
No one depends on me.
When you think of the future. Is there a specific period of time you’re worried about financially?
Choose
Not necessarily. I want something that will be there whenever we need
I worry about if something were to happen to me when my kids are young
I'm not sure. That's tough to think about.
How much risk are you willing to take with your money?
Choose
I'm happy to take risks often, but hope for high returns
I play safe, if I can.
I take risks sometimes. It depends on the situation.
What type of saver are you?
Choose
I like to set it and forget it. I auto pay those types of things.
I'll put money away if I have it, and spend if I needed.
I do a mixed of things, savings, investing, etc.
Do you own or rent your home?
*
Own
Rent
What is your desired policy length?
*
Choose
10 years
15 years
Option 3
25 years
30+ years
How much coverage would you like?
Choose
$10,000 - $50,000
$50,000 - $150,000
$150,000+
$250,000
$500,000
$750,000
Million+
When would you like coverage to start?
Choose
Immediately
Soon
Just researching
State of residence and what city do you live in?
*
Your answer
Send me a copy of my responses.
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