Your Investment Goals

Please take a moment to fill out the form below. The information that you provide will give our financial advisors a clearer understanding of your financial plans, so that they may assist you in establishing your investment portfolio.

After our advisors have reviewed your information, they will contact you to set up a convenient time to sit down and discuss your investment potential and future.

Contact Information
Name:
Address:
City:
State:
Zip:
Daytime Phone #:
Email:

Financial Goals
What do you feel is your most important financial goal?

How do you feel about saving for your children's education?
Very Important	Somewhat Important				No Children
How do you feel about renting versus buying a home?
Rent			Buy
How do you feel about your career?
Good		Bad		Indifferent
Have you had your social security benefits verified recently?
Yes			No
How do you feel about saving for retirement?
Very Important		Somewhat Important		Not Important
At what age you wish to retire?

How long could you live on your your reserves if you were disabled tomorrow and had major medical expenses?
Years
In your opinion, what percentage of income should be saved?
%
When investing money, what level of risk are you willing to take?
Substantial		Not any		In between
What is the most important thing in your world?

Areas you are interested in learning more about:
Tax Savings Retirement Planning Education Savings Wealth Accumulation	Estate Tax Savings Updating your Life Insurance Updating your Disability Insurance Insurance for your Business
How would you describe yourself?
My main objective is preserving my initial investment. I am interested primarily in receiving income and some growth.
I am interested in mainly in growth, with income and capital preservation as secondary. I have a time frame of at least five years.
My main objective is capital growth. I am willing to accept a higher level of risk and volatility in return for a higher rate of return on my investment. I have at least a five year time frame and possibly a significant length of time before I liquidate my investment.

All brokerage services transacted through Prime Capital Services, Inc., member FINRA (f/k/a NASD) and SIPC. Investments offered through Prime Capital Services, Inc. are not obligations of, guaranteed or insured by, any bank or any depository institution, the FDIC, or any other government agency. Investments subject to risk, including the possible loss of principal. Pamrapo Service Corporation (d/b/a Pamrapo Financial Center), a wholly owned subsidiary of Pamrapo Savings Bank SLA, and Prime Capital Services, Inc. are separate and unrelated companies.