Jon Gates, CRPC®
Financial Planner 
Investment Advisor 

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* 1. What is your first & last name?

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* 2. What is your current age?

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* 3. At what age do you plan to retire?

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* 4. What is your total annual income?

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* 5. How much do you contribute towards your retirement per year? (Express in percentage or dollar amount)

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* 6. How much do you currently have saved for retirement?

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* 7. What is your desired annual income during retirement?

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* 8. What is your biggest financial concern?

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* 9. If we were to meet, what topics would you be interested in discussing?

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* 10. Please provide your email address so that I can send you a customized response. 

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