First Name
Last Name
Mobile Phone NZ mobile format: 02xxxxxxxx
Email
Employment Status Contractor Retired Not Working Salaried Self-Employed
Financial Goal Design a financial strategy that is right for me Repay my mortgage faster Buy investment property Grow wealth with property & investments Get retirement ready
Household income Under $70k $70k - $120k $120k - $170k $170k - $220k $220k - $270k Over $270k
Total savings (excl. KiwiSaver)
Years Until Retirement More than 15 years Less than 15 years
Do you own property? Yes No
Total Property Value Numerical values only (can not use .,/$%)
Mortgage Debt Numerical values only (can not use .,/$%)
How did you hear about us? Digital (ie. Google, Facebook) Radio/TV Event/Webinar Referred by a friend Returning Client eBook
Referred By (Full Name)
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