Coaching Application

Name *

First

Last

Phone *

Email *

Are you or any members of your family currently employed or have ownership or partnership with any financial institution, financial service or financial education? *

If yes, please explain: *

Do you or any members of your family plan on being employed or have ownership or partnership with any financial institution, financial service or financial education after participating in 1:1 coaching sessions with Sam Seiden? *

If yes, please explain: *

Do you intend to educate clients or manage client money based on information you receive after participating 1:1 coaching sessions with Sam Seiden? *

If Yes, please explain: *

Do You Belong to any Trading Groups? *

If yes, please explain: *

What is your current level of experience with the Supply and Demand strategy? (1-10) *

How would you rate your current level of success with the Supply and Demand strategy? (1-10) *

I have experience in the following areas of trading/investing (select all that apply): *

Stocks/ETFs/Mutual Funds
Futures/Commodities
Forex
Options
Bonds
401k/IRAs

What financial life stage are you currently in? *

Just starting out
Still accumulating wealth
Nearing retirement
Retired

What inspires you to want to participate in 1:1 coaching sessions with Sam Seiden? (select your top three answers) *

Supplement my current income
Restructure or eliminate debt
Have enough money to retire
Protect your current wealth
Have enough resources to enjoy more of the things I value in life
Have enough income during retirement
Legacy planning for family
Donate to charitable organizations
Other (please specify):

Other? *

Disclaimer and Signature
I certify that all of the information I have provided to you is true and correct to the best of my knowledge. I also understand that participating in coaching sessions with Sam Seiden is at the discretion of the company and that at the time of the application, my application may be declined. I can reserve the right to reapply in 12 months and no bias or prejudice will be made by Pinnacle Financial Solutions, Inc regarding the denial of any prior applications by me.

Signature *

Clear Signature

Date *