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Client Survey

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Client Survey Powered By Docstoc
					Client Survey
      3 Reasons Why We Are Here Tonight:

               1. Referral Base                2. Earn your business as clients                   3. Expanding & Need Help

      Do you have someone right now who handles your current financial needs other than yourselves?                     Yes    No
      (If yes, are they open to make a change if we are able to improve and enhance their current situation?)

      First Names                                                            Last Name

      ________________________________________________________________________________________________________________________________


                                                                            Client                                    Spouse

      Current careers?

      What do you like about your current career?

      What Would You Change About it?

      If you could choose your annual income, what would it be? $__________________/ yr.

      What are some things that you and your family would do differently if time and money were no issue?
      For example: What’s important to you? What do you dream about? What’s Important to you?

      GOALS: ___________________________________________________________________________________________

      ___________________________________________________________________________________________________
                                  (Homes, Cars, Travel, Charities, Hobbies, Toys, Education, ect….)


      When will your current career allow you to accomplish those things?__________________

      If we can show you a way to help you reach your goals that would give you more money, security and freedom than your
      current career, would you be open to exploring that option?  Y      N

      What age are you on track for to be able to retire?_______     What is your ideal retirement age?_______
      If we can put together a plan to hit that goal, would you follow it? Y     N
_______________________________________________________________________________________________________________
                                                 Why I decided to get involved with Primerica.
                                                               (2 minutes or less)
_______________________________________________________________________________________________________________

      As I go through my presentation I want you to ask yourself 3 questions:

      1.   Is Primerica a credible company?

      2.   Is what Primerica does for families’ life changing?

      3.   Who do you know that would benefit from meeting with us? -Maybe this will help:
           Will you play a little game with me?
           Who can you think of right now (first names only) that is Married- Has kids- and a Homeowner?
           Also, who comes to your mind first when I say:
               Best Salesperson that’s not pushy- Best Teacher- Most Enthusiastic- Most Ambitious- Most Motivated

               (Look down at the referral sheet and start writing names as they say them, ask for as many as they can think of
               then start your presentation)
Financial Needs Analysis
  1.   INCOME AND RETIREMENT
           How much monthly income would you like to receive at retirement (today’s dollars)? $________________ per month
       ___________________________________________________________________________________________________________
       INCOME SOURCES                                                                           Client            Spouse
                                                      Monthly Gross (Pretax) Income         $_____________ $_______________

                                                                              Other Monthly Income       $_____________ $_______________
                                                                              Monthly Income Taxes       $_____________ $_______________
          Do you normally receive a tax refund? Y N                 If yes, how much do you anticipate this year? $__________________
              (If yes, explain interest free loan to government, for every $600 they get back, adjust W-4 by 1 dependant)
       ____________________________________________________________________________________________mo. Amt from tax refund
       RETIREMENT PLANS
                                                                                                       Client             Spouse
                Are you currently involved in any type of retirement plan 401k/ IRA’s etc?            Y       N           Y     N
                                                                       Current total balances     $_____________ $_______________
                                                      How much do you contribute monthly?         $_____ ______% $_______ ______%
                                  Does your employer match your retirement contributions?             Y       N           Y     N
                                                                                 How much?        $______ _____% $______ _______%

     _________________________________________________________________________________contributions with match
     FORMER RETIREMENT PLANS
                                                                                                  Client            Spouse
                                         Do you have assets from a previous employer?            Y      N           Y    N
                                   Have you rolled this over to a personal account yet?          Y      N           Y    N
                                              What are the balances in these accounts?      $_____________ $_______________
     ___________________________________________________________________________________________________________
  2. OTHER ASSETS
        Do you own any assets other than your home? Y       N            If YES: What is the value? $_____________________
     ___________________________________________________________________________________________________________
  3. NON-RETIREMENT ASSETS                                                                 Total Balance        Mo. Contribution?
                                                  Bank Saving /Checking/Em. Fund $________________                   $ $
                                                                          CD’s, Bonds $________________
                                                                Stocks, Mutual Funds $________________

  (If they have current investments ask)
         If we put together a savings solution that improves your current program, will you move your money with us? Y                N
       _____________________________________________________________________________________________________________
  4. EDUCATION DATA
        Do you want to pay for your children’s education? Y N                              If yes how much of it? ___________%
       _____________________________________________________________________________________________________________
  5. INSURANCE/ PROTECTION DATA
          Do you have a current will?             Y          N                If it was affordable, would you like to have one? Y     N
           (If NO, Print PLPP application with FNA and offer to enroll client on delivery of FNA)
           What do you pay monthly for…..?
                     Auto Ins. $________ Health Ins. $___________ Dental Ins. $___________ Cable/ Sat TV $_________
    ____________________________________________________________________________________________________________
     LIFE INSURANCE COVERAGE                                                                            Client           Spouse   Children
                         Do you have any Group Life Insurance coverage at work?                         Y    N            Y N      Y    N
                                                                                How Much?           $____________ $____________ $__________
                                How much of the premium do you pay per month                        $____________ $____________ $__________
           What happens to your employer paid group coverage if or when you leave your employer? ___________ (generally, you lose it)
          (Recommend to them not to rely on group insurance for their FNA, in case they change jobs, get a better offer elsewhere, or company changes benefits.)


          Do either of you use Tobacco in any form? Client: Y                    N           Spouse:     Y     N
Do you own personal life insurance other than through work?            Y    N
      IF NO: When a responsible family like yours doesn’t have life insurance outside of work, it’s usually because of one of the following reasons:
           A: Didn’t see the need for it.          B: They didn’t think they could afford it.          C: They never got around to it.
      IF YES: (Be sure to examine current policies)                                        Client               Spouse             Children
                                                                     What type?        ____________          ____________ __________
                                                             Company Name?             ____________          ____________ ___________
                                 What are your current monthly premiums?               ____________          ____________ ___________
                                                     What is the face amount?          ____________          ____________ ________life ins. prems
                                     How much cash value is in your policy?          $____________ $____________ $__________
                                                        When did you buy it?           ____________          ____________ ___________
     What is your relationship with the agent who sold you this insurance?             ____________________________
                   (If friend or relative ask: “if we can put together a better program, would you be open to changing?” Y N )
     ___________________________________________________________________________________________________________
6. DEBT MANAGEMENT DATA – HOME MORTGAGE (1ST)
    Mortgage Company: _____________ Purchase Price: $____________ Current Balance: $ ___________ Interest Rate _______%
     When did you buy your home? _______ Last refinanced? _______ The Term _______ Fixed/Variable_______ Home Value Now?___________
     Get Truth and Lending Statement from Client’s existing documents.
                PAYMENT DETAILS:
                             Principal & Interest Payment      $_________________       Additional Principal Payment: $_________
                                 Monthly Property Taxes        $_________________
                       Monthly Home Owners Insurance           $_________________       Homeowners Insurance Comp: __________
                  Private Mortgage Insurance (PMI/MIP)         $_________________ (if applicable)
                                  Total Monthly Payment        $_________________
     Is your current loan a 3/5/7 yr arm, Interest Only, etc?________________________
      _______________________________________________________________________________Overpayment on debts
     CONSUMER DEBT
                   Name                                 Balance                   Min. Pmt.               Actual Pmt.        Fixed    Rev.        Int. Rate
      2nd Mortgage                __       $______________          $____________        $ ___________        ________%
     Car #1____________________             $______________         $____________        $____________        ________%
     Car #2____________________             $______________         $____________        $____________        ________%
     Credit Card________________           $ ______________         $____________        $____________        ________%
     Credit Card________________           $______________          $____________        $____________         ________%
     Credit Card________________           $______________          $____________        $____________         ________%
     Other_____________________            $______________         $____________        $____________         ________%
     Other_____________________            $______________         $____________        $____________          ________%
     Other_____________________            $______________         $____________        $____________          ________%
   ____________________________________________________________________________________________________________
7. THE “PAY YOURSELF FIRST” FORMULA: Everyone’s life is different, but this should be used as a benchmark to shoot for.
    If you want “To Be”…
      Middle Class: Pay yourself first 10 percent or more of your gross income.
      Rich: Pay yourself first 15 percent or more of your gross income.
      Rich Enough to Retire Early: Pay yourself first at least 20 percent of your gross income.
      Which one do you want “To Be”? (Check one)

      That’s approximately $____________ per month.
      Is this an amount you feel completely comfortable committing to every month above what you’re currently doing? Y             N
      If no ask: How much of the $(mo. Amount) could you commit to putting away each and every month starting today? $
     ____________________________________________________________________________________________________________
8.   If you died prematurely, would you want your families standard of living to be:                                           Commitment
            Better           Worse      -or at least-      Stay the Same
9.   If you were to die prematurely do you want your…
           Mortgage/ Consumer Debt/ Children’s Education taken care of (paid off)? Y N
     If your debt were paid off how much monthly income would your survivors need?(help the clients understand that w/ out any monthly debt
     payments , they will most likely need much less per month to live on in comparison to what they need now with their monthly debt payments)
      If (client/spouse) died, your (wife/husband) and/or children would need $_____________ per mo. $______________ per mo.
                                                               Years Required: for ___________ yrs. for______________ yrs.
 If we put together an affordable Life Insurance program that adequately protects your family and improves upon your current
program, will you implement that program today? Y N
   (Have client fill out Personal Data page and call on AUTO & HOME while you calculate the coverage and premium amounts.)
   ________________________________________________________________________________________________________________
   CALCULATE COVERAGE AND PREMIUM BASED ON CLIENTS INFORMATION:


                                     Client: ________________
                                 3. Spouse:________________                                         7. Age 65:8%___________10%___________12%___________
                                    Child: _________________
        4.

                Mo. Prem.                                                                                              8. At Retirement
                                2. Today                                                                                  1. Grown children
                                    1. Young children
1.                                                                                                                        2. Lower debt
                                    2. High debt
                                                                                                                          3. Mortgage paid
      Mo. Commitment                3. House mortgage
                                                                                                                       9. Retirement income needed
      +Cur. Mo Invest                Loss of Income
      +Cur. Life Prem                                                                                                     You're Now Self-Insured!!!
                                    would be devastating
        5.

             Invest the Dif.
                               6. Current Ret Savings: $_____________
     (Compare the client’s current life insurance w/ the new solution w/ us if applicable).
      10. For the Life Insurance, how does that look for both the coverage and the monthly premium amount? Is it:
                                     A. Too High                B. Too Low            C. Perfect
      IF A or B:
                 -What amount would you feel more comfortable committing to? $__________________
                          (Make necessary adjustments to get the premium to where they want it).
     ADJUSTED SOLUTION (if necessary):
     Client ___________________ Spouse ___________________ Children ___________________ Monthly Amount $_________
      1. Is this new solution something you can commit to for the next 20 to 30 years or until we can help you become F.I.? Y N
      2. Have you ever had an issue qualifying for life insurance coverage in the past? Y              N
      3. Now that we’ve met, what is your understanding of what life ins is for? (Be sure they understand importance of getting and keeping ins.)
      4. Do you have any questions? Y N (If yes answer questions, if no say, “great what we’ll do is see if we can get you qualified for the coverage.”)
                       (Explain life application process and begin life application/ Turbo App.)
     _______________________________________________________________________________________________________________
     11. Complete SMART Loan Kit/ Debt Watchers
         A. are you 100% sure that you have the credit score you deserve? Y N Let’s find out…
      (Proceed by Showing debt watchers brochure and starting turbo app for debt watchers)
     For SMART Loan Kit remember to inform them they will be getting a letter from the solution center.
     (If objections remember only will implement if we lower time, lower interest dollars and/or the monthly amount)
     _______________________________________________________________________________________________________________
     12. If you like what you see when we return w/ your FNA, We will be asking for 10-15 quality referrals is that OK? Y N
     (Remind them to get names & numbers filled out from S.T.E.A.M, & you will pick them up at the carry back)
     _______________________________________________________________________________________________________________
     13. BUSINESS OVERVIEW/ INVESTMENT SEMINAR INVITATION
     Is there anything you can’t get out of _____@ 7pm? Since there’s nothing you can’t get out of I need you to be at my office at 7pm.
     Here’s the deal, I’m going to have a seat saved for you and your name on a list. So you promise me you’ll be there? Great, you’re a
     man/woman of your word right? Great I’ll see you ______@7pm, here’s the address…
     _______________________________________________________________________________________________________________
     14. SCHEDULE RETURN APPOINTMENT WITHIN 3-5 DAYS:                     Date:____/_____          Time: ___:_____ am/ pm
     IF NO IMPLEMENTATION ON FIRST VISIT:
     Also, so we can be sure we don’t waste each others time, if when I come back and I offer you a program that improves upon your
     current savings, debt situation, or insurance needs, will you implement and follow that program?     Yes No

     So the first thing we will get started on if there is an improvement is the income protection, so we’ll begin the application process
      and gather a check in the amount of $(Premium amount) O.K.? INITIAL HERE: CLIENT_______ SPOUSE ________
              (explain if necessary why the income protection process must be done before we can do anything else).
                                                                   Attachment A

The Financial Needs Analysis (FNA) is designed to assist you in identifying your financial needs and goals so that you can make better informed
decisions I managing your money. It has been developed based on the information you provide in this questionnaire and on certain generally
accepted assumptions and reasonable estimates. The FNA is provided to you as a complimentary, no obligation service by Primerica Financial
Services.

The calculations and assumptions are based on your current financial situation and today’s economic environment, which are subject to change. We
recommend that you review your financial needs and goals periodically to determine if you are making progress, especially when there is a change
in jobs, a change in marital status, or an addition to the family. As time passes and you financial situation changes, you should submit and new
questionnaire to see how the FNA’s suggestions change.

Representatives may represent the following affiliated companies: (a) as insurance agents in these respective jurisdictions: National Benefit Life
Insurance Company, Home Office, New York, NY, in New York; and Primerica Life Insurance Company, Home Office, Boston, MA in all other
U.S. jurisdictions; (b) in connection with mortgage loan applications, Primerica Financial Services Home Mortgages, Inc. (c) and, if securities
licensed, PFS Investments, Inc.

                                                                   For Use in U.S.

*The personal information you provide the Primerica Companies in preparation of your FNA may also be shared with other Primerica
representatives in your representative’s organization. This may be done in order to offer you products that may be appropriate for you. Otherwise,
your information will not be shared except as permitted by law.




                                                                   Attachment B

To ensure that we provide the best possible service to our clients, we ask you, by signing below, to verify and approve the information provided in
the questionnaire. We also want you to understand how this information will be used.

     •     I/we are providing this information to you, as my/our representative, and to Primerica Financial Services and its affiliates, to prepare a
           Financial Needs Analysis (FNA) in order to assist me/us in identifying financial needs and solutions. I/we understand that the results of
           this FNA are largely dependent on the information I/we have provided.
     •     I/we understand that this FNA is not an application for any financial product. By separate application, I/we may apply for one or more of
           the products mentioned in the FNA presentation, and be considered under the applicable qualification criteria/ I/we understand you may
           also share this information with other Primerica representatives to offer me/us products that may be appropriate for me/us.
     •     I/we understand that to avoid a need to provide this information on any subsequent applications, including any application to represent
           Primerica, information provided for this FNA can be imported into any Primerica application I/we complete in the future, regardless of
           the representative assisting me/us with the application. I/we will be sure that the information imported or otherwise included on an
           application is current and correct at the time the application is submitted.
     •     I/we, by signing below, confirm I/we have reviewed the information and approve it as use of the information by Primerica and its
           representatives as described above.

     Approved by:________________________________ Date:________________
     ARE YOU PAYING TOO MUCH?                                                                                               MAKE YOUR WISHES KNOWN
                 AUTO & HOME INSURANCE                                                                                                         LEGAL PROTECTION
     Steps to receiving a quote from Primerica Secure and                                                            It’s important to have a will.
     Insurance Answer Center. 1, 2                                                                                   If you don’t have a will and you die:
     1. It’s easy to get started. Simply call toll-free (877) 855-8111                                               •      A judge could be the one to decide who will raise your
        during call center hours of operation, or log on to                                                                 children.
        www.PrimericaSecure.com.                                                                                     •      The courts will distribute your money and your belongings.
                                                                                                                     •      A larger percentage of your money will go to paying for
            Call Center Hours of Operation:                                                                                 taxes.
            Monday-Friday: 8 a.m. to Midnight, ET
            Saturday: 9 a.m. to 8 p.m., ET                                                                           Did you know that 57% of adult Americans, as well as three
                                                                                                                     out of four parents, don’t have a will? 4,5
     2. What you’ll need to access Primerica Secure. Before
         you call or log on, be sure to have the following                                                           Do you ever plan to …
        information handy:                                                                                           •      Write or revise your will?
                                                                                                                     •      Purchase a new home?
            Representative’s Solution Number: ________________
                                                                                                                     •      Purchase a new or used car?
            Representative’s Last Name: _____________________
                                                                                                                     Legal risk is everywhere ... According to a study done for
            Additional information to have:                                                                          the American Bar Association, nearly 70% of U.S. households
            Auto Insurance Quotes                                                                                    had an issue during a typical year that might have led them to
            • All drivers’ Social Security numbers                                                                   hire a lawyer. 6
            • All Vehicle Identification Numbers (VINs)
                                                                                                                     And hiring a lawyer can be expensive ... A recent
            • Drivers Licenses for each insured driver
                                                                                                                     survey found that U.S. attorneys charge an average of $240
            • Declarations page of your existing policy
                                                                                                                     per hour.7
            Homeowner’s Insurance Quotes
            • The year your home was built                                                                           What are the chances of your needing legal
            • Square footage of your home                                                                            protection in the near future? Ask yourself the
            • Type of security devices in your home                                                                  following questions.
            •   Declarations page of your existing policy
                                                                                                                     Have you ever …
     •      Get competitive rate quotes in 10 minutes or less.                                                       • Purchased a defective product?
     •      Top-rated insurance providers help you get the best                                                      • Paid a bill you thought was unfair?
            coverage for your money.                                                                                 • Signed a legally binding document?
     •      You could save hundreds of dollars.                                                                      • Worried about an IRS audit?
                                                                                                                     • Received an unjustified traffic ticket?
     Insurance Companies                             Rating                    Estimated
                                                                           6-Month Premium
                                                                                           3                         • Been a defendant in a civil lawsuit?
                                            ®
     Safeco Insurance Co.                                    A                    $359
             ®                                                                                                       If you’re like most people, chances are you answered “yes” to
     Infinity                                                A                    $434
     The Hartford
                  ®
                                                             A+                   $466
                                                                                                                     one or more of these questions. Make each dollar count and
     Travelers Indemnity Company                             A+                   $521                               protect your rights. Enroll in the Primerica Legal Protection
     Unitrin Direct
                    ®
                                                             A                    $521                               Program today for peace of mind, security and legal
     Esurance
               ®
                                                             A                    $708                               empowerment.
                                                                                                                     One of the most important benefits of membership in the
                                                                                                                     Primerica Legal Protection program is the opportunity to draw
              Just call toll-free (877) 855-8111 or log on to                                                        up your will. Membership in the Primerica Legal Protection
               www.PrimericaSecure.com to get started!                                                               Program (PLPP) gives you access to professional legal
         CALL OR LOG ON TODAY … AND GET BACK TO YOUR                                                                 experts at top quality firms for as little as $25 per month. 8
                            LIFE!

1 Primerica (Primerica Financial Services Inc. and Primerica Financial Services Insurance Marketing Inc., CA License Number 0612256), its representatives and the Secure Program TM represent any of the insurers in the program.
Primerica, its affiliates and representatives offer other products and services. You are not required to apply for or purchase any other product or service in order to be considered for the Secure Program. Each product may be
applied for and purchased separately. 2 Answer Financial Inc., (the insurance agent) is not an insurance company. It is authorized to offer insurance products and services through its licensed affiliates Insurance Answer Center
Inc. (California License No. 0B99714), Answer Center Insurance Agency Inc., and other affiliates. Insurance Answer Center, Inc. represents insurance companies and is paid commissions and may receive other performance-based
compensation for the services provided to you. Rates are subject to change . All products may not be available in all states. . 3 Estimated 6-month premiums were calculated in October 2006, based on the following profile: single
 male, 24 years old living in California, driving a 2002 Dodge with no violations. Rates subject to change upon further underwriting. All products may not be available in all states.

4 CNNMoney.com, viewed on November 27, 2007 5 Kiplinger’s, July 2007 6 _Public Perception of Lawyers: Consumer Research Findings_ study, conducted in April 2002 for the American Bar Association by Leo J. Shapiro
& Associates 7 National Underwriter, October 24, 2005 8 Rates are different in NJ, NY and WA.
                                                                                                                                      You Can
                                                                                                                                       Do It!
                                                                                                                         Imagine how it would feel never
                                                                                                                           to worry about debt again.




Primerica, representatives of Primerica, Equifax and DebtWatchersTM will not act as an intermediary between DebtWatchers customers and their creditors and do not imply, promise or guarantee that credit files or credit scores
will or may be improved, repaired, boosted, enhanced, corrected or increased by use of DebtWatchers product. See http://my.primerica.com for additional Important Disclosures.
PERSONAL DATA
To be completed by the client. Please write legibly.
Print client’s data
 First Name                               MI                             Last Name                       Birth Date              Social Security #             Sex

 ________________________________________________________________________________________________________________________________________
 Drivers License #                 Issue Date                 Expiration Date            Birthplace – State         Country

________________________________________________________________________________________________________________________________________

Print spouse’s data
First Name                                MI                             Last Name                       Birth Date              Social Security #             Sex

________________________________________________________________________________________________________________________________________
Drivers License #                 Issue Date                 Expiration Date            Birthplace – State         Country

________________________________________________________________________________________________________________________________________

Beneficiary Info
Contingent Beneficiary Name                                              Relationship                                            Phone

__________________________________________________________________________________________________________(                          )_________________________




Print children’s data (if applicable)
Last                           First                           MI              Sex   Relationship   Birth Date        Height        Weight      Social Security #

________________________________________________________________________________________________________________________________________
Last                     First                      MI          Sex   Relationship  Birth Date    Height     Weight     Social Security #

________________________________________________________________________________________________________________________________________
 Last                    First                      MI          Sex   Relationship  Birth Date    Height     Weight     Social Security #

________________________________________________________________________________________________________________________________________
 Last                    First                      MI          Sex   Relationship  Birth Date    Height     Weight     Social Security #

________________________________________________________________________________________________________________________________________
 Last                    First                      MI          Sex   Relationship  Birth Date    Height     Weight     Social Security #

________________________________________________________________________________________________________________________________________

Mailing address and contact information
Address                                                                  City                            State          Zip                 Years at address

________________________________________________________________________________________________________________________________________
Home Phone               Work Phone              Fax               Cellular             Pager             Spouses Work

(      )                      (    )                   (   )                     (   )                  (    )                  (     )____________________
 E-Mail
 ________________________________________________________________________________________________________________________________________


 Clients Employer
 Name of Employer                                              Position Held                                              Date Hired

 ________________________________________________________________________________________________________________________________________
 Address                                                               City                       State             Zip

 ________________________________________________________________________________________________________________________________________

 Spouses Employer
 Name of Employer                                              Position Held                                                  Date Hired

_________________________________________________________________________________________________________________________________________
Address                                                               City                       State             Zip

_________________________________________________________________________________________________________________________________________
The greatest compliment you can give is your referrals.
       We will mention that we are helping you with your finances.

        Take 4 minutes and write down as many names possible in these 4 areas:
               1. Everyone related to you
               2. Friends and Acquaintances
               3. Anyone you’ve worked with
               4. People you know from your church


Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
_______________________________________________________________(____)_____________________(___)____________________________________________
Address                             City              State    Zip                         Relationship
__________________________________________________________________________________________________________________________________________
Comments

                  Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
_______________________________________________________________(____)_____________________(___)____________________________________________
Address                             City              State    Zip                         Relationship
__________________________________________________________________________________________________________________________________________
Comments

                  Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
_______________________________________________________________(____)_____________________(___)____________________________________________
Address                             City              State    Zip                         Relationship
__________________________________________________________________________________________________________________________________________
Comments

                  Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
_______________________________________________________________(____)_____________________(___)____________________________________________
Address                             City              State    Zip                         Relationship
__________________________________________________________________________________________________________________________________________
Comments

                  Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
_______________________________________________________________(____)_____________________(___)____________________________________________
Address                             City              State    Zip                         Relationship
__________________________________________________________________________________________________________________________________________
Comments

                  Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
_______________________________________________________________(____)_____________________(___)____________________________________________
Address                             City              State    Zip                         Relationship
__________________________________________________________________________________________________________________________________________
Comments

                  Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +
The greatest compliment you can give is your referrals.
      We will mention that we are helping you with your finances.

      Take 4 minutes and write down as many names possible in these 4 areas:
              1. Everyone related to you
              2. Friends and Acquaintances
              3. Anyone you’ve worked with
              4. People you know from your church


  Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
  _______________________________________________________________(____)_____________________(___)____________________________________________
  Address                             City              State    Zip                         Relationship
  __________________________________________________________________________________________________________________________________________
  Comments

                    Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




  Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
  _______________________________________________________________(____)_____________________(___)____________________________________________
  Address                             City              State    Zip                         Relationship
  __________________________________________________________________________________________________________________________________________
  Comments

                    Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




  Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
  _______________________________________________________________(____)_____________________(___)____________________________________________
  Address                             City              State    Zip                         Relationship
  __________________________________________________________________________________________________________________________________________
  Comments

                    Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




  Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
  _______________________________________________________________(____)_____________________(___)____________________________________________
  Address                             City              State    Zip                         Relationship
  __________________________________________________________________________________________________________________________________________
  Comments

                    Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




  Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
  _______________________________________________________________(____)_____________________(___)____________________________________________
  Address                             City              State    Zip                         Relationship
  __________________________________________________________________________________________________________________________________________
  Comments

                    Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




  Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
  _______________________________________________________________(____)_____________________(___)____________________________________________
  Address                             City              State    Zip                         Relationship
  __________________________________________________________________________________________________________________________________________
  Comments

                    Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +
The greatest compliment you can give is your referrals.
  We will mention that we are helping you with your finances.

   Take 4 minutes and write down as many names possible in these 4 areas:
          1. Everyone related to you
          2. Friends and Acquaintances
          3. Anyone you’ve worked with
          4. People you know from your church


 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +
The greatest compliment you can give is your referrals.
  We will mention that we are helping you with your finances.

Take 4 minutes and write down as many names possible in these 4 areas:
          1. Everyone related to you
          2. Friends and Acquaintances
          3. Anyone you’ve worked with
          4. People you know from your church


 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +




 Husband           Wife              Last Name                  Home Phone                  Work Phone                 E-Mail
 _______________________________________________________________(____)_____________________(___)____________________________________________
 Address                             City              State    Zip                         Relationship
 __________________________________________________________________________________________________________________________________________
 Comments

                   Age 25-55         Married           Children          Homeowner         Employed F-T         Income $25K +

				
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