Name *

First Name

Last Name

Phone *

(###)

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Investment purpose *

Which of the following statements below best describes your purpose for this investment account?

I want to minimize potential declines and significant fluctuations in the value of my account by investing in lower risk, more conservative investments.

I want a moderately high level of income (interest and dividends) from the account, with some modest growth opportunity over the long-term.

I prefer a balance of income (interest and dividends) with longer-term growth.

My primary goal is to maximize the value of my account as much as possible over a long-term timeframe.

Withdrawal timeline *

When will you begin withdrawing money from this specific investment account?

10+ years

5-10 years

3-5 years

1-3 years (for supplemental income needs, such as retirement).

I plan on immediately withdrawing money from this account.

Income expectations *

Over the next several years, you expect your annual income (salary, rental properties, pensions, social security, etc.) to:

Stay about the same

Grow moderately

Grow substantially

Decrease moderately

Decrease substantially

Portfolio goals *

Which of the five sample portfolios best represents your goals for this investment account and the most acceptable range of outcomes over a 1-year period?

Portfolio A: Average Return 4% Best Return 18% Worst Return -8%

Portfolio B: Average Return 5% Best Return 28% Worst Return -21%

Portfolio C: Average Return 7% Best Return 39% Worst Return -30%

Portfolio D: Average Return 8% Best Return 53% Worst Return -39%

Portfolio E: Average Return 10% Best Return 67% Worst Return -47%

Decline reaction *

If your investments were to decline in value significantly over a three month period, how might you react?

I would consider this decline as an opportunity to add to my investments

Because I invest for long-term growth, I can accept temporary fluctuations

Although I invest for long-term growth, a short-term decline would concern me

I would be very concerned because I can’t accept my account losing value

Personal investments *

In recent years, how have your personal investments changed?

My investments have shifted towards lower risk, lower return profile.

No meaningful change in the risk profile of my investments.

I have shifted my investments towards a higher risk, higher return profile