Information Survey

We want to hear from you! Please fill out this survey so that we can better address your needs. At Wilbanks Securities, Inc. we are a broker-dealer that listens to its representatives.

What is the most important feature of a broker-dealer to you?

(if Other)

What is the second most important feature of a broker-dealer to you?

(if Other)

What is the third most important feature of a broker-dealer to you?

(if Other)

Select the subject areas you are most interested in:
(Mark all that apply)

Pay-Outs
Technology
Product Lines
Compliance
Helpful and considerate service
Registered Investment Advisory capabilities
Independence - No propriatary products
Managing General Insurance Agency
Seminar selling system and marketing support
Other

How much would you be willing to pay for a complete educational seminar selling system that could potentially increase your sales by 100% to 500%?

What are the three most important features to you about a Registered Investment Advisory?

#1 (if Other)

#2 (if Other)

#3 (if Other)

What are the three most important features to you about a Managing General Insurance Agency?

#1 (if Other)

#2 (if Other)

#3 (if Other)

Which securities registrations do you currently have?

Series 6
Series 7
Series 63
Series 65
Series 24
Series 26

What insurance licenses do you currently have?

Life
Variable Annuity
Variable Life
Property & Casualty
A & H

What state(s) are you currently securities licensed in?

What state(s) are you currently insurance licensed in?

Please enter any comments that you may have:

10.

We would like to send you some literature. What is your mailing address?

Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Phone 3:	(Fax, Mobile, etc. - Please specify)
email:

For more information
call us toll-free at:
1-888-842-0202

© 1995 - 2007 by Wilbanks Securities, Inc. All rights reserved. No portion of this page or any portion of this website may be reprinted or otherwise duplicated without express written permission of Wilbanks Securities, Inc.