Agent Specific Assessment- Old Assessment

Vision

How important are these goals to you?

	Not important at this time	Important at this time	Very important at this time
Providing for surviving spouse or beneficiaries
Savings for emergencies
Supplemental retirement income in addition to social security
Gifting to family
Gifting to charities
Paying off business and/or personal debt
Treating all of your beneficiaries fairly
Maximizing tax-deductible retirement contributions
Increasing current income
Enjoying activities now and in the future that for some reason were delayed
Implementing retirement plans designated only (primarily) for the business owner.

At what age do you plan to retire? (Retire and retirement signify when you can fund your lifestyle from past, properly invested successes and not from active involvement in your business.)*
- 18 to 30
- 31 to 40
- 41 to 50
- 51 to 60
- 61 to 65
- 65 to 69
- 70+
In today's dollars, how much annual income will you need in retirement?*
- Less than $35,000
- $35,001 to $50,000
- $50,001 to $75,000
- $75,001 to $100,000
- $100,001 to $135,000
- $135,001 to $180,000
- $180,001 to $275,000
- $275,001 to $500,000
- Over $500,001
How much accessible cash will you need after age 65?*
- Up to $500,000
- $500,001 to $800,000
- $800,001 to $1,000,000
- $1,000,001 to $1,750,000
- $1,750,001 to $2,600,000
- $2,600,001 to $3,200,000
- Over $3,200,000
Structure and Compliance
Has your legal structure been reviewed by a lawyer and does it match your company's vision and exit strategy?*
What tax return do you file for your main business?*
Measurement
Do you pay your debts directly to a debtor?*
Do you pay your expenses to a vendor?*
Would you like to learn how to shorten your debt payment without changing your lifestyle by approximately 50%?*
Exit
Are you funding after-tax investments?*
Are you funding a 401(k)-type retirement?*
Are you funding a tax strategy just for you to decrease your future income taxes and provide for your retirement?*
Supplemental Questions
What are your 2 biggest tax & financial frustrations? (Please be sure to select 2)*
- Amount paid for income and payroll taxes
- Market losses on my investments
- Not enough gross revenue
- How easy money comes and goes for lifestyle
- Not enough money for the lifestyle I want
- Not sure I can reach the amount needed in the future
How do you feel about market loss and market gains?*
- I am comfortable with unlimited market gains and unlimited market losses.
- I am not comfortable with unlimited market gains and unlimited market losses
- I am comfortable with a cap on gains at 12% (+/-) and losses were capped at 0%
What is the primary purpose of the tax code?*
- To raise money for the government
- To raise money for the government with some loopholes benefiting others
- To help me succeed by providing substantial tax benefits
What is your age group?*
How much income tax did you pay last year? (Use lowest number within range).*
- $0 to $10,000
- $10,001 to $20,000
- $20,001 to $30,000
- $30,001 to $50,000
- $50,001 to $75,000
- $75,001 to $135,000
- $135,001 to $280,000
- $280,001 +
Contact Info
Name*
First Last
Business Name*
Email*
Phone*
State*
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Overpayed
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Email
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Vision

Structure and Compliance

Measurement

Exit

Supplemental Questions

Contact Info

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