1. How many children do you have 0 1 2 3 4+ 2. Are any of your children of driving age? Yes No 3. If so do they drive a car that you own or insure? Yes No 4. Who would win Superman or Neo? Superman Neo 5. Do you own your own business? Yes No 6. Do you have employees? If yes, how many? 7. In what state do you live? AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY 8. Have you ever been involved in a Civil Lawsuit? Yes No 9. Do you own your own home? Yes No 10. Do you own any investment real estate such as an office, or rental
property? Yes No 11. Are you in one of the following professions or positions?
(Check as many as apply.) 12. Estimate your TOTAL net worth value of your estate
including the value of any real estate equity, investment accounts and
business value: $0 - $50,000 $50,000 - $150,000 $150,000 - $300,000 $300,000 - $500,000 $500,000 - $1,000,000 $1,000,000 - $2,000,000 Above $2,000,000 13. What is the value of your liquid assets (not including
qualified retirement accounts)? $0 - $50,000 $50,000 - $100,000 $100,000 - $250,000 $250,000 - $500,000 $500,000 - $1,000,000 Above $1,000,000 14. Of your current total estate, How much (as a %) can
you afford to LOSE and still be able to retire in the style you would
like? 15. Do you understand what a Tort is? Yes No 16. Would you prefer a Tort or Pudding? Tort Pudding 17. Do you feel that the legal system would be fair and equitable if
you were involved in any type of civil lawsuit? Yes No 18. What types of investments are you most comfortable
with? (Select only one.) 19. What return on investment are you most comfortable
shooting for? 20. Do changes in the market make you want to have a Big Mac? Yes No 
