Founders Financial, Inc. - Confidential Member Inquiry

If someone is seeking a relationship with the best producer group and wants to associate themselves with like-minded, high quality professional, Founders Financial is the place to be. D Bauernschub, CLU, ChFC

Thank you for your interest in Founders Financial. At Founders, what sets us apart from other producer groups is exactly what makes us so strong - it's our commitment to our Members, to their success, and to our shared values. If you are ready to experience the difference and would like to schedule a one-on-one consultation with Founders CEO, Michael Brooks or to learn more about or to be considered for membership, please complete the information request form below.

* Required fields

Contact Information

* Full Name:

* Business Name:

* Title:

* Business Address:

(* Street)


(* City)	(* State)	(* Zip)

* Business Phone:		* Business Fax:
Private/Personal Email Address:		Web Address:
Tax ID or Social Security No.:

* Area(s) of Specialization:

* How many years have you been in business?

* Current B/D:

Current Insurance Resources:

* What licenses do you hold?

CLU	ChFC	CFP	CEP	CSA
Series 6	Series 7	Series 24/26	Series 63	Series 65/66
Other:

Production and Target Market Data

* What is your average annual production?

* Comprised of:

GDC: $		Insurance: $
Fee: $		Other: $

What is your current payout rate?

From where are your current revenues derived?

% of activity

	% Qualified Plans		% Financial Planning
	% Non-Qualified Plans		% Disability Income
	% Business Insurance		% Long Term Care
	% Estate Planning		% Employee Benefits
	% Charitable Planning		% Capital/Asset Management
			% Other:

What are your target markets?

	% Family Markets		% Executive Companies
	% Small Business		% High Net Worth
	% Senior Markets		% Professional Athletes
			% Other:

What is your approximate product mix break down?

	% Wrap Account Managment Fees		% Stocks
	% Separate Account Management Fees		% Municipal Bonds
	% Financial Planning		% Taxable Bonds
	% Mutual Funds		% UITs
	% Variable Annuities		% Options
	% Fixed Annuities		% Limited Partnerships
	% Variable Insurance		% Covered Calls
	% Fixed Insurance		% Other:

Personal Value Proposition

What is important to you?

While Founders Financial, Inc. is comprised of like-minded financial professionals, each is unique. Please share with us what specifically motivates you and what you seek professionally from a relationship with Founders Financial.

Historical Background of Your Organization
(Please provide a short overview of you and your organization)

Additional Information

What questions do you have about Founders Financial?

How did you hear about Founders Financial?

	Magazine Advertisement (Which magazine?)
	From a current Member (Please provide name)
	An Internet Search Engine (Which search engine?)
	Correspondence from Founders Financial
	Direct Mail from Founders Financial
	E-Mail from Founders Financial
	Other:

To establish your initial discovery meeting, please provide us with three convenient appointment options. We will be emailing you a meeting confirmation shortly after receiving and reviewing your request.

* Specific Date:		* Time of Day:
Specific Date:		Time of Day:
Specific Date:		Time of Day:

Shared Resources. Shared Values. - Founders Financial, Inc.