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Finance 101 Survey

Full Name *

Email *

Phone *

Invited by *

PERSONAL CHALLENGES

Are you concerned about any of the following?

Too many bills or debts? *

Yes

Lack of savings for retirement? *

Yes

Lack of preparation for your kid's college education? *

Yes

Not having enough protection in the case of disability, long term illness or even death? *

Yes

Do you support children, aging parents or other dependents? *

Yes

Are you concerned about the future of your job or career? *

Yes

Do you feel that concepts involving insurance, debt, inflation, tax, and other financial services are confusing? *

Yes

When saving for the future, what results are you going after? *

Interest

Safety

What is your current age? *

What is your ideal retirement age? *

FINANCIAL OPTIONS

Do you want to learn how to fund your child's college or university costs? *

Yes

Do you want to learn more about how money works and how to build a stronger financial foundation? *

Yes

Are your interested in making more money on a part-time basis? *

Yes

Do you want to explore a new business career in the fast growing financial industry? *

Yes

Check all the applies to you:

I'd like to discuss:

Free Financial Workshop

Personal Financial Check-up

Retirement Strategies

Debt Management

Budgeting

Life Insurance

Disability Insurance

Mortgage Protection

Business Solutions

Part-time Opportunity

Long-Term Care Insurance

Living Benefits

Estate Preservation

College Funding Options

What days are you available?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What time of the day are you available?

Morning

Afternoon

Evening

Would you like to be informed of future financial literacy workshop events? *

YES

WSB Bay Area Financial Center

1818 Gilbreth Road, Suite 230

Burlingame, CA 94010

[email protected]

(415) 335-5957