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Step 1 of 3 - Personal Information 33% Name* First Middle Last Date of Birth* Date Format: MM slash DD slash YYYY Primary Email Address* Secondary Email Address (if applicable) Cell Phone*Home Phone (if applicable)Physical Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a separate mailing address?*NoYesMailing Address (If different from physical address) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employment Type*Employed (W2)Self-Employed (1099)HomemakerRetiredOtherEmployer Name*Approximate Years with EmployerOccupation*Employer Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Are you affiliated with any FINRA securities firm?YesNoAre you a 10% shareholder, director, or policy-making officer for any publicly traded company?YesNoDo you have a spouse/partner?*YesNo Spouse/Partner* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Spouse Date of Birth* Date Format: MM slash DD slash YYYY Spouse Primary Email Address* Spouse Secondary Email Address (if applicable) Spouse Cell Phone*Spouse/Partner Employment Information*Employed (W2)Self-Employed (1099)UnemployedHomemakerRetiredEmployerApproximate Years with EmployerOccupationSpouse Work Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business PhoneDo you have any children?YesNoChild(ren) InformationFirst NameLast NameDate of Birth 1. I plan to begin taking money from my investments in...*A. 1 year or lessB. 1 - 2 yearsC. 3 - 5 YearsD. 6 - 10 YearsE. 11 - 15 yearsF. More than 15 years1b. (Spouse/Partner) I plan to begin taking money from my investments in...*A. 1 year or lessB. 1 - 2 yearsC. 3 - 5 YearsD. 6 - 10 YearsE. 11 - 15 yearsF. More than 15 years2. As I withdraw money from these investments, I plan to spend it over a period of...*A. 2 years or lessB. 3 - 5 yearsC. 6 - 10 yearsD. 11 - 15 yearsE. More than 15 years2b. (Spouse/Partner) As I withdraw money from these investments, I plan to spend it over a period of...*A. 2 years or lessB. 3 - 5 yearsC. 6 - 10 yearsD. 11 - 15 yearsE. More than 15 years3. When making a long-term investment, I plan to keep the money invested for...*A. 1 - 2 yearsB. 3 - 4 yearsC. 5 - 6 yearsD. 7 - 8 yearsE. More than 8 years3b. (Spouse/Partner) When making a long-term investment, I plan to keep the money invested for...*A. 1 - 2 yearsB. 3 - 4 yearsC. 5 - 6 yearsD. 7 - 8 yearsE. More than 8 years4. I would describe my knowledge of investments as:*A. NoneB. LimitedC. GoodD. Extensive4b. (Spouse/Partner) I would describe my knowledge of investments as:*A. NoneB. LimitedC. GoodD. Extensive5. From September 2008 through November 2008, stocks lost more than 31% of their value. If I owned a stock investment that lost 31% of its value in three months, I would ...(If you owned stocks during this period, please select the answer that matches your actions at that time.)*A. Sell all of the remaining investmentB. Sell some of the remaining investmentC. Hold on to the investment and sell nothingD. Buy more of the investment5b. (Spouse/Partner) From September 2008 through November 2008, stocks lost more than 31% of their value. If I owned a stock investment that lost 31% of its value in three months, I would ...(If you owned stocks during this period, please select the answer that matches your actions at that time.)*A. Sell all of the remaining investmentB. Sell some of the remaining investmentC. Hold on to the investment and sell nothingD. Buy more of the investment6. Generally, I prefer an investment with little to no up or downs in value, and I am willing to accept the lower returns these investments may make*A. I strongly disagreeB. I disagreeC. I somewhat agreeD. I agreeE. I strongly agree6b. (Spouse/Partner) Generally, I prefer an investment with little to no up or downs in value, and I am willing to accept the lower returns these investments may make*A. I strongly disagreeB. I disagreeC. I somewhat agreeD. I agreeE. I strongly agree7. When the market goes down, I tend to sell some of my riskier investments and put the money in safer investments*A. I strongly disagreeB. I disagreeC. I somewhat disagreeD. I agreeE. I strongly agree7b. (Spouse/Partner) When the market goes down, I tend to sell some of my riskier investments and put the money in safer investments*A. I strongly disagreeB. I disagreeC. I somewhat disagreeD. I agreeE. I strongly agree8. Based on only a brief conversation with a friend, coworker, or relative, I would buy their recommended investment*A. I strongly disagreeB. I disagreeC. I somewhat agreeD. I agreeE. I strongly agree8b. (Spouse/Partner) Based on only a brief conversation with a friend, coworker, or relative, I would buy their recommended invesment*A. I strongly disagreeB. I disagreeC. I somewhat agreeD. I agreeE. I strongly agree9. From September 2008 through October 2008, bonds lost nearly 4% of their value. If I owned a bond investment that lost almost 4% of its value in two months, I would...(If you owned bonds during this period, please select the answer that matches your actions at that time.)*A. Sell all of the remaining investmentB. Sell some of the remaining investmentC. Hold on to the investment and sell nothingD. Buy more of the investment9b. (Spouse/Partner) From September 2008 through October 2008, bonds lost nearly 4% of their value. If I owned a bond investment that lost almost 4% of its value in two months, I would...(If you owned bonds during this period, please select the answer that matches your actions at that time.)*A. Sell all of the remaining investmentB. Sell some of the remaining investmentC. Hold on to the investment and sell nothingD. Buy more of the investment10. The chart below shows the highest one-year loss and the highest one-year gain on three different hypothetical investments of $1,000,000. Given the potential gain or loss in any one year, I would invest my money in...*A. Investment AB. Investment BC. Investment C10b. (Spouse/Partner) The chart below shows the highest one-year loss and the highest one-year gain on three different hypothetical investments of $1,000,000. Given the potential gain or loss in any one year, I would invest my money in...*A. Investment AB. Investment BC. Investment C11. My current and future income sources (such as salary, Social Security, pension) are...*A. Very unstableB. UnstableC. Somewhat stableD. StableE. Very stable11b. (Spouse/Partner) My current and future income sources (such as salary, Social Security, pension) are...*A. Very unstableB. UnstableC. Somewhat stableD. StableE. Very stable12. When it comes to investing in stock or bond mutual funds (or individual stocks or bonds), I would describe myself as...*A. Very inexperiencedB. Somewhat inexperiencedC. Somewhat experiencedD. ExperiencedE. Very experienced12b. (Spouse/Partner) When it comes to investing in stock or bond mutual funds (or individual stocks or bonds), I would describe myself as...*A. Very inexperiencedB. Somewhat inexperiencedC. Somewhat experiencedD. ExperiencedE. Very experienced13. You understand the value of investments will fluctuate over time, depending on the amount of risk taken. What is the approximate loss in any one-year period that you would be willing to accept before deciding to change your investments?*A. Less than (5%)B. (5%) to (10%)C. (10%) to (15%)D. (15%) to (25%)E. (25%) or more13b. (Spouse/Partner) You understand the value of investments will fluctuate over time, depending on the amount of risk taken. What is the approximate loss in any one-year period that you would be willing to accept before deciding to change your investments?*A. Less than (5%)B. (5%) to (10%)C. (10%) to (15%)D. (15%) to (25%)E. (25%) or more14. Consider two different investments: Investment A, which provides an average annual return of 5% with a minimal risk of loss of value, and Investment B, which provides an average annual return of 10% and a potential loss of 25% or more in any year. How would you divide your investment dollars?*A. 100% in Investment A and 0% in Investment BB. 80% in Investment A and 20% in Investment BC. 50% in Investment A and 50% in Investment BD. 20% in Investment A and 80% in Investment BE. 0% in Investment A and 100% in Invesment B14b. (Spouse/Partner) Consider two different investments: Investment A, which provides an average annual return of 5% with a minimal risk of loss of value, and Investment B, which provides an average annual return of 10% and a potential loss of 25% or more in any year. How would you divide your investment dollars?*A. 100% in Investment A and 0% in Investment BB. 80% in Investment A and 20% in Investment BC. 50% in Investment A and 50% in Investment BD. 20% in Investment A and 80% in Investment BE. 0% in Investment A and 100% in Invesment B15. When I invest my money, I am :*A. Most concerned about my investment losing valueB. Equally concerned about my investment losing or gaining valueC. Most concerned about my investment gaining value15b. (Spouse/Partner) When I invest my money, I am :*A. Most concerned about my investment losing valueB. Equally concerned about my investment losing or gaining valueC. Most concerned about my investment gaining valueDo you need a budget template?*YesNoDo you have a Long Term Care (LTC) policy, life insurance outside of work, and/or disability coverage outside of work?*YesNoListInsured's NameType of Coverage (LTC/Life/Disability)Amount of Coverage Do you have a Will?*YesNo
