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Please indicate the type of life insurance that you prefer
 
Term
 
Whole life
 
Universal life
 
Variable life

 
 

Please indicate your tolerance for risk in investing
 
High risk tolerance
 
Medium risk tolerance
 
Low risk tolerance-very conservative
 
 

Please indicate the type of saver you consider yourself
 
Excellent saver
 
Very good saver
 
Moderately good saver
 
Poor saver
 
 

How long do you intend on keeping your term insurance policies if you have them
 
Only as long as needed
 
For my entire lifetime
 
Do not have term life insurance
 
 

How long do you intend on keeping your permanent or whole life insurance polices if you have them?
 
Ten years
 
Twenty years
 
Thirty years
 
For your entire lifetime
 
Do not have whole life or permanent insurance policies
 
 

What other types of investments do you have? You can choose more then one choice.
 
Passbook savings
 
CD's
 
Money market account
 
Mutual funds
 
Stocks
 
Bonds
 
Precious metals
 
IRA's, 401k, retirement accounts
 
Real estate
 
Other
 

 
 
 
Please indicate the age group you belong to
 
20 years to 30 years
 
31 years to 40 years
 
41 years to 50 years
 
51 years to 60 years
 
61 years to 70 years
 
71 years and over
 
 

Please indicate if you are male or female
 
Male
 
Female
 
 

Please indicate your marital status
 
Single
 
Married
 
Divorced
 
 

Please indicate the size of your immediate family including yourself and your partner
 
One
 
Two
 
Three
 
Four
 
Five
 
Six
 
Seven
 
Eight
 
Other
 
 
 

Please indicate your level of education
 
High school diploma
 
Associate degree
 
Bachelor degree
 
Masters degree
 
Doctorate
 
 

Please indicate closest to your career
 
Skilled laborer- Construction, etc
 
Service industry worker
 
Teacher
 
Business owner
 
Professional-doctor, lawyer, accountant etc.
 
Stock broker
 
Retail worker
 
Working in research or science field
 
Other
 
 
 

Please indicate your approximate yearly income
 
0-$20,000
 
$20,001-40,000
 
$40,001-60,000
 
$60,001-80,000
 
$80,001-100,000
 
$100,001-150,000
 
$150,001-200,000
 
$200,001 and over
 
 

How many weeks of vacation do you take in a year
 
One
 
Two
 
Three
 
Four
 
Other
 
 
 

What types of leisure activities do you and your family enjoy
 
Sports
 
Movies
 
Traveling
 
Museums
 
Other
 

 
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