1. What age group are you in?	34 and younger 35-44 45-54 55-64 65-74 75+
2. Are you married?	No Yes
3. How many children do you have?	0 1 2 3 4 5+
4. Total household income:	$20k - $30k $30k - $40k $40k - $50k $50k - $60k $60k - $70k $80k - $90k $90k - $100k $100k+
5. What is your Total Debt?
6. What is your life insurance coverage?	None > $250k $250k - $350k $350k - $450k $450k - $550k $550k+
7. Combined auto values:
8. Home Value:	None (Rent) $50k - $100k $100k - $150k $150k - $200k $200k+
9. Total 401K and Pensions:
10. IRA Amount:
11. Long Term Care:
12. Disability Coverage:	No Yes
13. Savings Account Balance:	$0-$1,000 $1k-$5k $5k-$15k $15k-$50k $50k-$100k $100k+
14. Your Zip Code:

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