First Name
Last Name
Email
Phone Number
How did you hear about us?
Internet
Radio
Seminar
Talks
Other
On a scale of 1-10 rate your committment to wealth building
1
2
3
4
5
6
7
8
9
10
Do you have a current retirement account?
Yes
No
What type of retirement account do you currently have? (check all that apply)
401k
403b
457
ROTH
Pension
IRA
SIMPLE IRA
How much is in the retirement account?
$1,000 - $50,000
$50,000 -- $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1M
$1M+
Are you over the age of 55?
Yes
No
Do you have an educational savings account setup for your children?
Yes
No
What areas are you interested in? (check all that apply)
Education
Finance
Insurance
Precious Metals
Real Estate
Self Directed IRA
Are you interested in seeking a graduate or doctoral degree?
Yes
No
Do you have traditional health insurance?
Yes
No
Are you interested in supplemental health insurance?
Yes
No
Do you have life insurance?
Yes
No
Are you interested in premium finance insurance?
Yes
No
Are you interested in private placement life insurance
Yes
No
By submitting this form you accept and consent that a Real Estate Group Partners team member will contact you regarding your submission.
Submit
Subscribe To Our Newsletter