A. DISABILITY INCOME

1. Would your income continue, if you were too sick or hurt to work?  Yes No
2. Would this cause a cash-flow problem?  Yes No
3. How do you feel about this situation?  Yes No
4. What steps have you taken to solve this problem?  Yes No

B. LIFE INSURANCE
1. Would the income to your family continue in the event of your death?  Yes No
2. Would your debts and future financial obligations be funded at your death?  Yes No
3. How do you feel about this situation?  Yes No
4. What steps have you taken to solve this problem?  Yes No

C. CASH ACCUMULATION
1. Do you have a regular system of accumulating money?  Yes No
2. Do you have specific accumulation objectives?  Yes No
3. Do you feel your current methods of accumulating money will meet these objectives?  Yes No
4. Does your plan take advantage of current tax benefits?  Yes No

D. BUSINESS PLANNING
1. Do you have a business continuation plan?  Yes No
2. Do you have a company sponsored retirement plan?  Yes No
3. Do you presently have any other employee benefit programs?  Yes No
4. Do these plans take advantage of current tax benefits for you and your employees?  Yes No

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