First Name:
Last Name:
Telephpone:
Email:

How many dependents will rely on you for financial support over the next 5 years?

None

One

Two

Three

Four or more

Your compensation is likely to increase at the following annual rate:

Decline

Stay the same

Increase with inflation

Increase 0% - 4% more than inflation

Increase over 4% more than inflation

Your current liquid saving and investments would allow you to pay your living expenses for:

Less than 3 months

3 - 6 months

6 - 12 months

1 - 2 years

More than 2 years

You are more comfortable knowing you have a fixed rate of return rather than the possibility of a higher or lower rate of return in the future

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

It is more important for you to:

Avoid losses

Keep pace with inflation

Keep pace with the stock market

Outperform the stock market

Having liquid investments available for unforeseen expenses is important to me

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

You would be comfortable investing in a company that has norevenues, based on the company's potential to capitalize on proprietary, cutting-edge technologies

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

If you could potentially get a higher rate of return by accepting greater volatility in some or all of your investments, you would:

Accept a lot more volatility with all your money

Accept slightly more volatility with some of your money

Not accept any more volatility

If a $10,000 investment you made for the long term declined in value during the first year, but the fundamentals of the company remained the same, at what point would you sell in favor of a more stable investment?

$9,500

$9,000

$8,500

$8,000

I would not sell

What is your investment time horizon?

0 - 2 years

3 - 5 years

6 - 8 years

9 + years