Name *

First Name

Last Name

Phone *

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Q1: At what stage are you of your working life?

I am not working but may work again.

I am of working age but have no plans to work.

I am employed or involved in business activities.

I plan to retire in the next five years.

I am retired.

Q2: Which of the following best describes your primary financial goal?

Preservation of capital.

Income.

Growth and income.

Growth.

Aggressive growth.

Q3: Where do you anticipate most of your revenue to come from in future years?

From employment or my business activities.

From my investment portfolio.

From fixed pension income.

I am not sure.

Q4: What is your household annual income?

Less than $50,000.

Between $50,000 and $100,000.

Between $100,000 and $150,000.

Between $150,000 and $250,000.

Over $250,000.

Q5: You have enough liquidity to cover expenses for:

One month or less.

2 to 3 months.

4 to 6 months.

6 months to 1 year.

More than 1 year.

Q6: What is your time horizon for this investment?

Short term.

Five to ten years.

Long term.

Q7: How do you feel about the stock market?

I like a significant allocation to stocks for growth.

Include the right allocation to stocks based on my goals and risk tolerance.

The stock market is risky for me. I would like to avoid it.

Q8: What is your level of investment experience?

Limited.

Average.

Extensive.

Q9: Which of the following statements describes your preference of investment management styles?

I want a concentrated portfolio of companies based upon a specific investment theme.

I want a quantitative investment portfolio that is typically available only to large institutional investors like pension funds, hedge funds, and private foundations.

I want a low-cost, professionally managed portfolio based on the investment strategies found in the Building Blocks section of this website.

Q10: What is your appetite for risk versus returns with this investment?

I prefer a lower risk portfolio.

I can tolerate moderate risk to achieve moderate returns.

Aim for higher long-term returns with more risk short term.

Q11: Aim for higher long-term returns with more risk short term.

Any loss would be uncomfortable.

10%

20%

30%

40% or more.

Q12: What is your net worth not including home, furnishings and auto?

Less than $50,000.

Between $50,000 and $100,000.

Between $100,000 and $250,000.

Between $250,000 and $500,000.

Between $500,000 and $1,000,000.

Over $1,000,000.

Q13: What is the total size of your investment portfolio?

Less than $100,000

Greater than $100,000 and less than $500,000

Greater than $500,000 and less than $750,000

Greater than $750,000 and less than $1,000,000

Greater than $1,000,000