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Name ____________________________________________
Email ____________________________________________
City _____________________________
State_____________
Best Telephone # to reach me ____________________
Best time of day to reach me ___________________
Age ________ Retired ( _____ yes _______no)
What is your goal? _______________________________________________________
Own physical Silver or Gold now? _________
Type/description (optional) ________
How long owned? _____________ Estimated % of wealth? _______________
Other areas of wealth (check all that apply) IRA / 401k/ SEP/ etc. ____ brokerage account/ stocks, bonds, etc. ____ annuities ____ cash, money markets ____ real estate ____ private equities ___ other __________________________________ (describe)
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Fidelity Gold & Silver, Inc.
999 Vanderbilt Beach Road, Suite 200
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(office and fax) (866) 415-2739