Speed Date

People speed-date so they don't get trapped in an uncomfortable relationship. You don't want to feel stuck and neither do we. So, our first visit is like speed-dating. If we don't hit it off, it's our last date and nobody has to pick-up the tab, because it's free! You've already snuck around the internet to check us out. So, it only seems fair that we gather a few details about you. Who knows, we might be a match!

What is your name?

First Name

Last Name

What is your age?

Age

Who is your employer?

Employer Name

Retired

Describe your profession:

I am:

Married Single Widowed Divorced

What is your spouse's name?

First Name

Last Name

What is your spouse's age?

Spouse Age

Who is your spouse's employer?

Employer Name

Retired

Describe your spouse's profession:

Do you have children?

Yes No

What are their ages

Where do you live?

Street Address

City

State

Zip

What is your primary telephone number?

What is your spouse's primary telephone number?

Is it OK to contact you at work?

Yes No

If yes, what is your work number and extension?

What is your cell phone number?

What e-mail address should we use to contact you?

What e-mail address should we use to contact your spouse?

What is your current level of financial frustration and/or concerns?

Please describe your most urgent concerns:

What is your annual household income?

$250,001+ $150,000 - $250,000 $100,000 - $150,000 $75,000 - $100,000 Less than $75,000

How much do you save annually? (Do not include employer-match contributions)

What is your current net worth (assets minus liabilities), excluding primary residence and automobiles?

$1,000,000 + $500,000 - $1,000,000 $250,000 - $500,000 $100,000 - $250,000 $50,000 - $100,000 Less than $50,000 Not Sure

I believe my investment knowledge is:

Extensive Moderate Limited

Have you been referred to our office by a friend?

Yes No

If Yes, who referred you?

Is there a specific advisor you would like to engage?

Yes No

If Yes,

Mark Bertrang Nathan Becker

Is there anything else our office should know about your situation, before we get together?

What is the best time to contact you?

Morning Afternoon

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Our office will contact you soon to schedule your free preview visit.

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Bertrang Financial Corp. | 1401 Main Street, Suite #101, Onalaska, WI 54650-2837
Phone: 608 782-5433 | Fax: 608 782-1329 | Sitemap

Securities offered by Fortune Financial Services, Inc., member FINRA & SIPC. Advisory services offered by Interactive Financial Advisors, Inc. Bertrang Financial Corp. offers non-securities based insurance as an independent business. Bertrang Financial Corp., Fortune Financial Services, Inc. and Interactive Financial Advisors, Inc. are separate entities. © Bertrang Financial Corp. 2024
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