ORDER REPORTS

Name:*
Married?*
E-mail:*
Today's Date:*
Have you set up your personal account with the Social Security Administration (www.ssa.gov)? If not, we highly recommend that you do. Why, because this allows you to manage your benefits online.*
Date of Birth*
Mailing Address:*
Daytime Phone Number:*
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Evening Phone Number:*
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Are you currently receiving SS income?*
When did you begin receiving? If no, type "N/A."*
Current check amount*
If not, benefit from last SSA statement, age 66**
What is your ideal retirement age?*
Are you flexible in this decision?*
Do you plan to work during retirement?*
If yes, estimate income. If not, type "N/A."*
Are you collecting a pension from an employer who did not collect SS taxes from you?*
If yes, annual benefits and when did you begin receiving? If not, type "N/A."*
Dependent children?*
Does your family have a history of short (75), average (85), or long (95) life expectancy? *
Projected life expectancy?*
Year Married?
Ever Divorced?*
Year Married, if Divorced.
Year Divorced:
Widowed?*
Year Married, if Widowed:
Year Spouse Died:
Name of Spouse:*
Spouse's Date of Birth*
Spouse's Email:*
Spouse's Mailing Address:*
Spouse's Daytime Phone Number:*
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Spouse's Evening Phone Number:*
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(Spouse) Are you currently receiving SS income?*
(Spouse) When did you begin receiving? If no, type "N/A."*
Spouse's Current check amount:*
(Spouse) If not, benefit from last SSA statement, age 66**
(Spouse) What is your ideal retirement age?*
(Spouse) Are you flexible in this decision?*
(Spouse) Do you plan to work during retirement?*
(Spouse) If yes, estimate income. If not, type "N/A."*
(Spouse) Are you collecting a pension from an employer who did not collect SS taxes from you?*
(Spouse) If yes, annual benefits and when did you begin receiving? If not, type "N/A."*
(Spouse) Dependent children?*
(Spouse) Does your family have a history of short (75), average (85), or long (95) life expectancy? *
(Spouse) Projected life expectancy?*
(Spouse) Year Married?
(Spouse) Ever Divorced?*
(Spouse) Year Married, if Divorced.
(Spouse) Year Divorced:
(Spouse) Widowed?*
(Spouse) Year Married, if Widowed:
(Spouse) Year Spouse Died:
Select Payment Option:*
To submit, type the letters you see in the box and then click submit.