FFM - College Funding Request Form

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:

Securities are offered through Girard Securities, Inc. member FINRA, SIPC.
Mark R. Fielder, Registered Principal. CA. Insurance Lic. # 0690576.