The Company You Keep
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Business Strategies Personal Agent Match

Please fill out the form below and we will match you up with a New York Life agent in your area that can help analyze your business needs and recommend appropriate solutions through insurance and financial products and concepts.

Information About Your Business

Name of your business?
Nature of the business?
Address
Phone Number (Required)
Area Code and Phone Number
Fax Number
Area Code and Fax Number
E-mail
What is your legal form of business?
Sole proprietorship?
Partnership?
S Corp?
C Corp?
If yes, what is the tax bracket?
Number of owners:
DOB
Do you have a buy-sell agreement? Yes No
Is it funded? Yes No
How did you get started in this business?
If you were selling your business today, how much would you ask for it?
Events That Affect Your Business

When you retire, what will you do with your business?
Sell it to a family member? Sell it to an outsider?
Gift it to a family member? Close your business?
Sell it to a key employee?
When you retire, where will your retirement income come from?
Pension? Sale of your business?
Personal savings? Have not thought about it.
What percent of your total estate is made up by your business?
1/3 or less? 1/2 or more?
In the event of your premature death what would happen to your business?
Would it have to be sold? Would it have to be close?
I'm not sure!
In the event you became disabled what would happen to your business?
Would you have to sell it? Continue?

For how long?

Would you have to close it?
Not sure?
If you became disabled what would happen to your personal income?
Stop? Continue?

For how long?


Paid by?
Information About Your Employees

How many employees do you have?
If any employees are key to your business, how many?
Do you have any supplemental programs to help retain "key" employees, such as Executive Bonus, Non-qualified Deferred Compensation, Salary Continuation?
Yes No
If you are hiring any additional employees in the next six months, how many?
What is your turnover rate?
Benefit Programs For Your Employees

Do you have a group health plan?
Yes No
Company?
Type:
HMO/PPO Major Med Dental Life DI
Percentage of premiums paid by the business:
Are you satisfied?
Yes No
Renewal date?
Do you have any qualified or voluntary payroll deduction plans?
Yes No
If Yes, explain
If you were to increase or provide additional benefits who would you want to benefit most?
Owner-employees Non-owner employees
With that in mind, pick two of the three items listed below that are most important to you:
Tax deductible to the business Not currently taxable as income
Pick and choose who benefits
Is providing added value programs important to you?
Yes No
Your Agent's Name

What is your agent's name?
(If you don't have one, please leave this blank.)

Rate
Rating: 4.7/5 (3 votes cast)

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Business Strategies Personal Agent Match

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