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Financial and Estate Planning Wealth Accumulation and Distribution Contact Us 1. Have you ever had a financial plan produced for you before? Yes No 2. What are your primary goals/concerns at this time related to financial planning? Risk Assessment Asset Allocation Investment Planning Portfolio Management Business Planning College Planning Tax Planning Education Planning Retirement Planning Long Term Care Insurance Planning 3. Are you currently a Parker/Hunter, a divison of Janney Montgomery Scott LLC client? If so, who is your Financial Consultant? If you are not a client, how did you hear about us? Internet search Radio Television Print: Newspaper Print: Magazine Direct Mail Attended a Seminar Attended an Event P/H Sponsored (investors fair, expo, etc.) Referral from a family member, friend, co-worker, etc. Other: 4. My specific question about financial planning: 5. Contact Me: * Required Field First Name: * Last Name: * Company Name: Title: Address: City: State/Province: * Select: N/A AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Postal Code: Email: * Phone: ( ) Fax: ( ) Other Information: Please call: (Best time) a.m. p.m. Please mail literature Please inform me of seminars Please also send information to: YES, I do   NO, I do not allow a representative from Parker/Hunter, a division of Janney Montgomery Scott LLC, to contact me by phone in response to information I've requested here. < Back

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