Reality Retirement Score Free Report & Videos Free Consultation

Please fill out this form completely and press "submit" at the bottom of the page when you are through. Omit the dollar sign ($) when inputing money values.


First Name    
Last Name    

Email Address

    
Phone Number    
Extension    
Pass Code   This is the pass code that was either provided to you in person, by letter, by email, or in some form of advertising such as magazine, radio or TV.
Resident 5-digit Zip Code    
       
Current Annual Income ($):   Enter your current gross annual income.
 
Desired Post-Retirement Income (%):
(As % of Current Income)
   Enter the percentage of your current income that you project you will need during retirement to maintain your standard of living.
 
Assumed Long-term Inflation Rate (%):   Enter the percent you feel that inflation will rise on average during retirement. Since 1913, statistics show an annual average inflation rate of 3.3%. Since 1972, the inflation rate has ran at a 4.78% annual clip. A 2.5% to 5% inflation rate is a reasonable projection.
 
 
Current Age:   Enter your current age rounded up to the next whole year.
 
Desired Retirement Age:   Enter you desired retirement age rounded to the nearest whole year.
 
Life Expectancy:   Enter the age you expect to live to.
 
Expected Annual Pension ($):   If you're vested in a company-provided pension, enter the yearly amount you expect to receive during retirement. Contact your company's benefit office for this information.
 
Expected Social Security Benefit ($):   Enter the yearly amount you expect to receive from Social Security during retirement. The Social Security office sends you a benefit statement each year with precise benefit information. Otherwise, you can use these very general guidelines:

  • If you make under $25,000, enter $8,000
  • Between $25,000 - $40,000, enter $12,000
  • Over $40,000, enter $14,500
    		•
    Age Social Security Begins (Min 62):   Enter the age at which you expect to start receiving social security benefits. Full benefits are available at age 65 and reduced benefits are available at 62.
     
    Money you have currently saved for retirement ($):   Enter the money currently in retirement savings: 401k, 403b, IRA, Money Market, CDs, etc.
    Expected average annual savings for retirement ($):   Enter the money you continue to save annually for retirement.
    Assumed Investment Return (%):   Enter the average annual long-term investment return you expect to earn on your retirement savings. The default is 7%.
     
     

    Please click only once, then wait for the acknowledgement screen to appear.

       
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