Please fill out this Needs Analysis Form so we can start working on a customized policy tailored to your needs.

If your answer is ZERO, please type in 0

Name *

Email *

Birthdate MM/DD/YY *

How much will you need?

Current debt estimation *

What is your estimated final expense needs? (Average $15,000) *

Current monthly mortgage or rent *

Do you have any student loans? (Future- avg. $100k/child or current balance owed) *

Yearly Income (How much income would your family have to replace if you were gone?) *

Retirement Funding Sources

How much can you afford to save for your retirement per month? (Not counting what you are already saving) *

If you currently have life insurance, what is your monthly premium? *

Current monthly IRA/401k contribution *

How much did you get back from the most current tax refund? *

Turbocharge your policy

Total amount of non-qualified funds (any monies you have saved that have ALREADY been taxed. ex- cash, checking, savings, stock) *

Total amount of qualified funds (PRE-TAX monies placed into a retirement savings account) *

Disclaimer: By filling out this form I am giving expressed consent to Planting Seeds Financial to use my information for the purposes of agent/client privlidges. This information is being given at will to Planting Seeds Financial, LLC. Planting Seeds Financial nor its affilliates will use any information from this form for use for any reason other than stated above.

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