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Personal Attention

    Please complete the following questions so that The Smart Money Gal, Jean Ann Dorrell, CEP®, can better evaluate your needs and provide you with the very best personalized attention possible!

        Contact information
      Your Name*:
    Your Spouse's Name:
    Your Email*:
    Home Phone:
    Cell Phone:
    Address:
     
    City* State* Zip*:

        Work & Family Information
      Occupation:*
    How many Children do you have?*    How many Grandchildren?*
    Do you have a Retirement Plan with your work?   YesNo
    If yes, which Financial Institution Administers it for your office?    

    Do you have a Retirement Plan outside of your work?   YesNo
    If yes, at which Financial Institution is it located?    

        Financial Objectives
           Please rank the following according to your level of concern, where 1 is not concerned and 10 would be Very Concerned
    Planning for Children, Grandchildren
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    Reducing Current Income Taxes
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    Increasing Current Income
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    Estate Planning
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    Desire for Professional Management
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    Maximum Growth
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    Combined Growth & Income
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    Simplifying My Investments
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    Preservation of Assets
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    Questions or Comments
      What is your biggest concern with regard to your Estate Plan?*