Request An Annuity Quote

Agent Name

Please Quote:

Single Premium Deferred Annuity
Flexible Premium Deferred Annuity
Equity Indexed Annuity
Single Premium Immediate Annuity
E-mail
Phone
Client Name
State
Gender

Male Female

Date of Birth / /
or Actual Age
or Nearest Age
Initial Deposit
Qualified Money Yes No
If you are quoting an immediate annuity, please enter your client's choice of payout options (example: 10 years certain and life, monthly payout, beginning one month from deposit date)
Please Quote the Following Options... With the Following Carriers...

Short Surrender Period
Surrender Period Doesn't Matter
High First Year Bonus Rate
Long Guaranteed Rate
No Market Value Adjustment
High Commission Products
A+ or Better Company

 
Best Quote Possible
American General
American National
F and G
GE Capital
 Jefferson Pilot
Lincoln Benefit
ReliaStar
ING/USG
Notes or Concerns:
Illustration Delivery:
E-mail in Adobe PDF file format
E-mail of important numbers only
Fax
U.S. Mail
Call with premium numbers
Will pick up
Other
Please Include:
Application kit for quoted state
A.M. Best Report
Contracting
Marketing Materials: please specify
AgentSuite