By providing the following information, we can provide you with a free written investment proposal. If you prefer to speak to someone or meet in person, just call us at 501.623.1141 or toll free at 877.723.6975.

If you have an existing investment portfolio, dont' forget to request a free portfolio analysis.

Your information:

Full Name:
Date of Birth:

Spouse's information:

Full Name:
Date of Birth:

E-mail address:

Home:

Street
City State Zip

Phone numbers:

Phone
Cell
Work
Spouse's Work
Other

How much money do you plan on investing in this account?
Example: "$200 / month" or "$200,000 one-time" or maybe "$200,000 one time and $200 / month."

Which of these accurately describes your response to this statement: "I am comfortable with market value fluctuations and can tolerate a losing year every 3 to 5 years."

strongly agree
agree
not sure
disagree
strongly disagree

When will you need to take money out of this investment account?

over 15 years
11-15 years
5-10 years
3-4 years
less than 3 years
not sure

How would you describe your investment experience?

I am very experienced with investments and am comfortable with market fluctuations.
I have a good amount of investment experience.
My investment experience is limited.
I have no investment experience yet.

What will this money be used for?

Retirement
College
Infrequent purchases (home, car, etc)
Other:
not sure

Please select one of the following that best describes your objectives with this invested money:

My main goal is to preserve the money in this account. I am not concerned with growth in the account. I would rather accept risk of taxes and inflation than that of the stock market.
I prefer to limit stock market risk yet still attain some equity growth. Most of my portfolio should be in fixed investments in order to avoid volatility.
I would like a predominantly equity-based portfolio. I wish to have a substantial amount of growth within the portfolio but still have diversification through fixed investments.
Growth is my main focus. I wish to invest almost exclusively in equities. I am willing to accept high volatility for a potentially higher long-term rate of return.
I wish to have all money invested into equities. I am willing to tolerate maximum volatility in hopes of a higher long-term rate of return. I have a long-term time frame and can accept large drops in my account from time to time.
Not sure

Biblically-responsible investing:
Would you like to use Christian-screened investments where possible? These investment options screen out companies involved with Pornography, Abortion, Anti-family Entertainment, Alcohol, Tobacco, Gambling, and Gay/Lesbian Lifestyles.
Yes No

Have you been working with any particular representative of Christian Financial Principles?

Notes
Are there any additional notes or comments you'd like to add about the information mentioned above?