FFM - 162 Executive Benefit Plan

162 Executive Benefit Plan Request Form

Please complete the following request form to receive FREE information on Section 162 Executive Bonus Plans. Please note: All fields must be completed.

  Name:         
  Address:    
  City:         State/Province: 
  Zip Code:   
  Email:      
  Home Phone:   
  Work Phone: 
  
  Employee's Name: 

  Employee's Date of Birth: 
     Yes    No   
    
  Employee's tax bracket is:
     28%    31%    36%    39.6%    Unknown
  
  Bonus/Payment Amount:                
  Expected Number of Bonuses/Payments: 

  Employee's Position: 
  
  What is the possible time frame for implementing such a program?
     Less than one month    1 to 3 months    3 to 6 months

  Your general awareness on this subject is:

  Are you a Financial Advisor? (RIA, stockbroker, insurance agent, fee planner):
     

  Additional Comments/Questions:

Securities offered through Fortune Financial Services, Inc. member FINRA, SIPC. Fielder Financial Management, Ltd. not affiliated with Fortune Financial Services, Inc. Mark Fielder, Financial Professional, CA. Insurance Lic. # 0690576.