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* 1. Name:  (First & Last)

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* 2. Email & Phone Number:

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* 3. What is your total Annual Household Income?

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* 4. What are your total Monthly Household Expenses?  (approximate)

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* 5. What is your total outstanding Debt that you owe? (approximate)

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* 6. How much Retirement Assets do you currently have saved?    What savings do you have outside of retirement accounts?(approximate)  

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* 7. What dollar amount is saved per month in Retirement Accounts?  What dollar amount is saved per month in Non-Retirement accounts? (approximate)

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* 8. How much do you estimate you spend on gifts and travel annually?

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* 9. How much life insurance coverage do you have to protect your family?

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* 10. Do you currently own a Long Term Care policy?  How much is the annual premium?

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