College Funding Request Form

Please complete the following confidential request form to receive FREE information on saving strategies for college. Please note: All fields must be completed.

  Name:         
  Address:    
  City:         State/Province: 
  Zip Code:   
  Email:      
  Home Phone:   
  Work Phone: 
  Your Age:   

  College Planning Strategy most interested in:
    
      
  The age of the first child to attend college: 	
  The age of the second:				
  The age of the third:			        	
  The age of the fourth:				

  I consider myself a:
     Aggressive Investor    Moderate Investor   
     Conservative           Willing to accept NO risk  
  
  Are you a mutual fund investor?
     Yes   No
    
  Your tax bracket is:
     28%    31%    36%    39.6%    Unknown
  
  Amount you may want to consider investing: 
     Single    Quarterly    Semi-Annually    Annually

  Your estimated time frame to purchase a plan is:
     Less than one month    1 to 3 months    3 to 6 months


  Additional Comments/Questions:
  

   

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All Rights Reserved.

Securities offered through Fortune Financial Services, Inc. member FINRA, SIPC.  Fielder Financial Management, Ltd. not affiliated with Fortune Financial Services, Inc.  Mark Fielder, Financial Professional, CA. Insurance Lic. # 0690576.