*Does having control of your retirement funds in cash appeal to you? Yes No

*Are you interested in cashing out all or part of your retirement account? Yes No

*How interested are you?
Not at all A Little Interested Very I want it NOW!

*Are you or were you in the military? Yes No

*Are you retired? Yes No     

*Pay grade at retirement (if not yet retired, what is your anticipated pay grade)? O-10 O-9 O-8 O-7 O-6 O-5 O-4 O-3 O-2 O-01 O-3E O-2E O-1E W-5 W-4 W-3 W-2 W-1 E-9 E-8 E-7 E-6 E-5 E-4 E-3 E-2 E-1

*Age to the nearest 6 months? *Years of service? 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years

*In which branch of military did you serve? Army Navy Air Force Marines Coast Guard National Guard

*What is your monthly retirement income from this branch of the military?
Gross: Net:

*Is your retirement pay subject to any liens, garnishments,
or other encumbrances? Yes No    

   *Is your retirement VSI? Yes No
       

   *Is a percentage of your retirement from VA Disability? Yes No

*How did you learn about the VFFS, Inc. CORP program?
Local Newspaper (Virginian Pilot - Ledger Star) Local Newspaper (Daily Press) Local Newspaper (San Diego Union Tribune) Local Newspaper (Other) National Newspaper (USA Today) National Newspaper (Wall St. Journal) National Newspaper (Investors Business Daily) National Newspaper (New York Times) Radio Magazine Television Internet Direct Mail Word of Mouth Referred by Participant    

*Are you Married? Yes No

*Do you have any Dependent Children? Yes No    

*Do you have another job, or will you continue working
after leaving the military? Yes No

Please carefully review all information you have provided and make any necessary changes. After you have completed and reviewed the form, click the "Submit Information" button below.