Financial Independence
Financial Services Survey
1. Age Group:
20-25
26-31
32-37
38-43
44-50
51-60
Over 60
2. Occupation:
3. Marital Status
Single
Married
Number of Dependents:
4. If you could save money each month, would you consider consolidating all of your debt into one lower montly payment?
Yes
No
5. If you could save up to $450 a year on your auto & homeowners insurance, would you want more information?
Yes
No
6. Do you have life insurance?
Yes
No
7. What type of life insurance do you have?
Please select...
Whole Life
Universal Life
Term
Through Work
Other
8. Do you think you are saving enough for retirement?
Yes
No
9. Do you contribute to a retirement program?
Yes
No
10. If you could contribute to a tax-free retirement program, would that appeal to you?
Yes
No
11. Would you be interested in a financial road map if it were complementary?
Yes
No
12. If you could earn an extra $1,000 to $1,500 a month educating people on financial matters, would that interest you?
Yes
No
13. If our research finds a way to save you money or bring more money into your household, may we contact you with this information?
Yes
No
Contact Information:
First Name
Last Name
Address:
Contact Phone:
Best Time To Call:
Email Address:
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