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											| Are you already a Wells Fargo Advisors client? | Yes 
													No | 
								
									
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											| How would you describe your main investment goal?
 | Growth Income
 Preservation of Capital
 Reduce Taxes
 Portfolio Diversification
 
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										|  Please check the areas you would like to discuss, and check if you are interested in attending a seminar on the topic:
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                      | Estate and Retirement Planning: | 
 
 
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                      | Stocks, Bonds, and Mutual Funds: | 
 
 
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                      | Comprehensive Financial Planning: | 
 
 
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                      | Education Planning | 
 
 
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                      | Annuities and Insurance | 
 
 
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                      | Trust Services | 
 
 
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                      | Lending Services | 
 
 
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											| How often would you like to review your financial goals and progress
 with your financial advisor?
 | Once a quarter Every 6 months
 Once a year
 
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											| Please estimate your Net Worth:
 | $10,000 - $50,000 $50,000 - $100,000
 $100,000 - $250,000
 $250,000 - $500,000
 $500,000 - $1,000,000
 More than $1,000,000
 
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											| Please estimate your Total Portfolio Value:
 | $10,000 - $50,000 $50,000 - $100,000
 $100,000 - $250,000
 $250,000 - $500,000
 $500,000 - $1,000,000
 More than $1,000,000
 
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											| How would you like to be contacted? | E-mail 
													Mail 
													Telephone | 
								
									
										
											| If you would like to be contacted by telephone, when would be
 an appropriate time to contact you
 concerning your financial needs?
 | Morning 
													Afternoon 
													Night | 
								
									
										
											|  | Weekday 
													Weekend | 
								
									
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