Primary Account Holder Name *

First Name

Last Name

Secondary Account Holder Name (if applicable)

First Name

Last Name

1. What is your current age? *

Less than 45

45 to 55

56 to 65

66 to 75

Older than 75

2. When do you expect to start drawing income? *

Not for at least 20 years

In 10 to 20 years

In 5 to 10 years

Not now, but within 5 years

Immediately

3. What is your goal for this investment? *

To grow aggressively

To grow significantly

To grow moderately

To grow with caution

To avoid losing money

4. Assuming normal market conditions, what would you expect from this investment over time? *

To generally keep pace with the stock market

To slightly trail the stock market, but make a good profit

To trail the stock market, but make a moderate profit

To have some stability, but make modest profits

To have a high degree of stability, but make small profits

5. Suppose the stock markets performs unusually poorly over the next decade. What would you expect from this investment? *

To lose money

To make very little or nothing

To make out a little gain

To make a modest gain

To be little affected by what happens in the stock market

6. Which of these statements would best describe your attitudes about the next three years' performance of this investment? *

I don't mind if I lose money

I can tolerate a loss

I can tolerate a small loss

I'd have a hard time tolerating any losses

I need to see at least a little return

7. Which of these statements would best describe your attitudes about the next three months' performance of this investment? *

Who cares? One calendar quarter means nothing

I wouldn't worry about losses in that time frame

If I suffered a loss of greater than 10%, I'd get concerned

I can only tolerate small short-term losses

I would have a hard time stomaching any losses