Name:           
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  I am most interested in: Free Estate AnalysisLiving TrustTax Free Inheritance Trust (Irrevocable Trust)Gifting StrategiesFamily Limited PartnershipCapital Gains By-Pass Trust (Charitable Remainder Trust)Charitable Split DollarFoundationUnsure, Please Help!!
  			     
  Your Estate is valued at approximately: $600,000 to $1,000,000$1,000,000 to $3,000,000$3,000,000 to $5,000,000$5,000,000 to $10,000,000Above $10,000,000
  
  Your occupation is: 

  I currently have a:
     Will                  Living Trust         Irrevocable Trust
     Family Partnership    Family Foundation    Charitable Remainder Trust
    Other, please specify: 
  
  Your time frame to implement such a plan is:
     Less Than One Month    1 To 3 Months    3 To 6 Months

  Would you like to receive a free 40-minute audio cassette tape?
     Yes    No

  Your general awareness on this subject is:
    NoneLowMediumHighVery High 

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

  Additional Comments/Questions: