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Please Enter Your Company Name
 
 
 
 
Which policies do you have?
 
Life Cover
 
Life/Critical illness cover
 
Income protection - against illness / injury
 
None

 
 
 
If you have one of the previously mentioned insurances, what are you paying?
 
Not applicable
 
Less than £10
 
£10-£20
 
£20-£30
 
£30-£40
 
£50-£60
 
£60-70
 
£70-£80
 
£80-£90
 
£100+
 
 
 
If you don't have any insurance to protect your family / finances why not?
 
Cost
 
I don't believe they pay out
 
It will never happen to me
 
I'm worried I'll take the wrong policy
 
I've not got around to it
 
I have cover in place
 
 
 
If you have insurances - how do you make your choice in terms of which policy you will take out?
 
Online Comparison sites
 
Advice from parents/ family / friends
 
I take professional advice and make my decision
 
Other
 
 
 
 
Your situation, please tick which ones apply to you
 
Single
 
Married /Living with a partner
 
Only earner supporting partner
 
Only earner supporting partner & family
 
Housewife / Househusband
 
Incapacitated & unable to work
 
Living with parents / family
 
I live on my own
 
I work
 
I do not work
 
My Partner earns more than me
 
I pay maintenance
 
I receive maintenance that I am reliant on
 
Other
 

 
 
 
Fountain Financial Services are professional advisers dealing with arrangement and advice on:
Income Protection against illness / injury
Buildings & Contents insurance
Life cover
Critical Illness cover
Would you like a review on your insurances or to discuss your own needs? (this can be in person if Northampton based or over the phone if not local or for your ease).
 
Yes
 
No
 
 
 
If you know of someone that would like a call to discuss their needs, please enter their details below & your understanding of what they are looking for.* If they proceed with a Life / critical illness policy or Income protection policy with us we will pay you £25.00 as a thank you. Terms apply, please get in contact for full details.Please post our link for your friends to use
   
 
 
You own contact Information for our reference
* First Name : 
* Last Name : 
Phone : 
 
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