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First Name*
Last Name*
Primary Email*
Mobile Phone *
Owns Primary Residence
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Yes
No
Mortgage Balance
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Fully paid off
Mortgage balance under 50%
Mortgage balance over 50%
I don’t have a mortgage
Owns Investment Properties
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Yes
No
Investment Cash Flow
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Yes
Consistently
Sometimes
No
Additional Income
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Yes Multiple
One Source
No
Payment Comfort Level
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Very comfortable
Somewhat comfortable
Not comfortable
Readiness Timeline
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Immediately
Within 6 months
Within a year
Just researching
Are you contributing to a retirement account?*
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Yes
No
Target Retirement Age
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Under 65
55-65
Over 65
Prefer Tax-Advantaged Plan?*
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Yes
No
Message *
Questionnaire
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