ÿþ<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd"> <html> <head> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> <title>Asset Allocation Questionnaire</title> <link href="asset_allocation_proj.css" rel="stylesheet" type="text/css"> </head> <body> <form name="frm" action="/cgi-bin/FormMail.aa.pl" method="post" onsubmit="return validate(frm)"> <table width="1000" border="0" cellspacing="0" cellpadding="0"> <tr> <td>&nbsp;</td> </tr> <tr> <td class="title"><font size="+1">"Your Best Interest" Financial Services Inc.<br>Asset Allocation Questionnaire</font></td> </tr> <tr> <td><hr size="1" noshade></td> </tr> <tr> <td>&nbsp;</td> </tr> <tr> <td class="text">Please take a few minutes of your time to help us to determine the best asset mix for your retirement plan. </td> </tr> <tr> <td class="text">&nbsp;</td> </tr> <tr> <td class="text"><table width="81%" border="0" cellspacing="6" cellpadding="0"> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"><b>Please Enter Your Name</b><br><input type="text" name="realname"><br><br></td> </tr> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"> <B>What is your current age? </B><br> <input type="radio" name="q1" value="a"> Younger Than 45<br> <input type="radio" name="q1" value="b"> 45 to 55<br> <input type="radio" name="q1" value="c"> 55 to 65<br> <input type="radio" name="q1" value="d"> 65 to 75<br> <input type="radio" name="q1" value="e"> Older than 75<br><br> </td> </tr> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"> <B>When do you expect to start drawing income?</B><br> <input type="radio" name="q2" value="a"> Not for at least 20 years<br> <input type="radio" name="q2" value="b"> In 10 to 20 years<br> <input type="radio" name="q2" value="c"> In 5 to 10 years<br> <input type="radio" name="q2" value="d"> Not now, but within 5 years<br> <input type="radio" name="q2" value="e"> Immediately<br><br> </td> </tr> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"> <B>What is your goal for this investment?</B><br> <input type="radio" name="q3" value="a"> To grow aggressively (gain with regards to losses)<br> <input type="radio" name="q3" value="b"> To grow significantly (grow a lot)<br> <input type="radio" name="q3" value="c"> To grow with caution<br> <input type="radio" name="q3" value="d"> To grow moderately<br> <input type="radio" name="q3" value="e"> To avoid losing money<br><br> </td> </tr> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"> <B>Assuming normal market conditions, what would you expect from this investment over time?</B><br> <input type="radio" name="q4" value="a"> To generally keep pace with the stock market<br> <input type="radio" name="q4" value="b"> To slightly trail the stock market, but make a good profit<br> <input type="radio" name="q4" value="c"> To trail the stock market, but make a moderate profit<br> <input type="radio" name="q4" value="d"> To have some stability, but make modest profits<br> <input type="radio" name="q4" value="e"> To have a high degree of stability, but make small profits<br><br> </td> </tr> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"> <B>Suppose the stock market performs unusually poorly over the next decade, what would you expect from this investment?</B><br> <input type="radio" name="q5" value="a"> To lose money<br> <input type="radio" name="q5" value="b"> To make very little or nothing<br> <input type="radio" name="q5" value="c"> To eke out a little gain<br> <input type="radio" name="q5" value="d"> To make a modest gain<br> <input type="radio" name="q5" value="e"> To be little affected by what happens in the stock market<br><br> </td> </tr> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"> <B>Which of these statements would best describe your attitudes about the next three years? </B><br> <input type="radio" name="q6" value="a"> I don't mind if I lose money<br> <input type="radio" name="q6" value="b"> I can tolerate a loss (it bothers you but tolerable)<br> <input type="radio" name="q6" value="c"> I can tolerate a small loss<br> <input type="radio" name="q6" value="d"> I'd have a hard time tolerating any losses<br> <input type="radio" name="q6" value="e"> I need to see at least a little return<br><br> </td> </tr> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"> <B>Which of these statements would best describe your attitude about the next three months' performance of this investment?</B><br> <input type="radio" name="q7" value="a"> Who cares? One calendar quarter means nothing<br> <input type="radio" name="q7" value="b"> I wouldn't worry about losses in that time frame<br> <input type="radio" name="q7" value="c"> If I suffered a loss of greater than 10%, I'd get concerned<br> <input type="radio" name="q7" value="d"> I can only tolerate small short-term losses<br> <input type="radio" name="q7" value="e"> I'd have a hard time stomaching any losses<br><br> </td> </tr> <tr> <td>&nbsp;</td> <td class="text"><div align="left"></div></td> <td><!td colspan="0"> <B> Is there any additional Information we should know</b><br> <textarea rows=10 cols=40 NAME="extra Info"></textarea> </td> </tr> <tr> <td>&nbsp;</td> <td>&nbsp;</td> <td><input type="submit" name="Submit" value="Submit"> <input type="reset" name="Submit" value="Clear"></td> <td>&nbsp;</td> <td>&nbsp;</td> </tr> </table></td> </table> </form> <script language="javascript"> function validate(frm) { var inputFields = new Array("formmail_mail_email" ,"q1" ,"q2" ,"q3" ,"q4" ,"q5" ,"q6" ,"q7" ,"extra Info"); var counter; var name; var msg = "Please complete the following fields:\n"; var badFields = ""; for (counter = 0; counter < inputFields.length; counter++) { name = inputFields[counter]; if (frm.elements[name].value.length == 0) { if (name == "formmail_mail_email") { badFields = badFields + " - email address \n"; } else { badFields = badFields + " - " + name + "\n"; } } } if (badFields.length != 0) { alert(msg + badFields); return false; } if (frm.formmail_mail_email.value.length > 0) { return emailCheck(frm.formmail_mail_email.value); } else { return true; } } function emailCheck(emailStr) { var emailPat=/^(.+)@(.+)$/; var specialChars="\\(\\)<>@,;:\\\\\\\"\\.\\[\\]"; var validChars="\[^\\s" + specialChars + "\]"; var quotedUser="(\"[^\"]*\")"; var ipDomainPat=/^\[(\d{1,3})\.(\d{1,3})\.(\d{1,3})\.(\d{1,3})\]$/; var atom=validChars + '+'; var word="(" + atom + "|" + quotedUser + ")"; var userPat=new RegExp("^" + word + "(\\." + word + ")*$"); var domainPat=new RegExp("^" + atom + "(\\." + atom +")*$"); var matchArray=emailStr.match(emailPat); if (matchArray==null) { alert("Email address seems incorrect (check @ and .'s)"); return false; } var user=matchArray[1]; var domain=matchArray[2]; if (user.match(userPat)==null) { alert("The username doesn't seem to be valid."); return false; } var IPArray=domain.match(ipDomainPat); if (IPArray!=null) { for (var i=1;i<=4;i++) { if (IPArray[i]>255) { alert("Destination IP address is invalid!"); return false; } } return true; } var domainArray=domain.match(domainPat); if (domainArray==null) { alert("The domain name doesn't seem to be valid."); return false; } var atomPat=new RegExp(atom,"g"); var domArr=domain.match(atomPat); var len=domArr.length; if (domArr[domArr.length-1].length<2 || domArr[domArr.length-1].length>3) { alert("The address must end in a three-letter domain, or two letter country."); return false; } if (len<2) { var errStr="This address is missing a hostname!"; alert(errStr); return false; } return true; } </script> </body> </html>