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WEALTH BUILDING STRATEGY QUESTIONAIRE
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Name
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Who referred you?
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Phone number
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Email
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Your answer
What are you hoping to accomplish so we can better help you? (go ahead, you can choose multiple)
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I need to save for retirement
I need affordable life insurance
I want to set up a plan for my kids
Income replacement incase I lose my job due to sickness or injury
Learn about Index Funds , Infinite Banking, Rockefeller Wealth Plan, more
I wouldnt mind obtaining a state Life insurance License for additional income
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Who are you interested in helping with our services? check all that apply
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Yourself
Spouse
Parents
Children
Family
Business/ Business Partner
Employees
Church/ Pastor/ Congregation
Other
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How much are you wanting to grow and/or protect every year/month? Check all that apply
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$300/mo or less
$300/mo+
5k yr/400mo+
10kyr/800mo+
25k yr/2400mo+
I have a 401k/IRA/ Account I want to protect and grow.
I have a bunch of money sitting in the bank and I want to put it somewhere that's growing.
I'm more interested in Life Insurance and Living benefits
I have a budget of $30-$300mo for life Insurance
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What's a income Goal that you desire to achieve for your family?
$25,000-$50,000+ Year income
$50,000-$100,000+ Year income
$150,000-$250,000+ Year income
$300,000-$500,000+ Year income
$750,000 -$1,000,000+ Year income
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How soon are you looking to implement a Financial Plan to accomplish those goals?
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Is there anything else you would like us to Know?
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