Tools & Resources
Agent/Agency Profile
Business Growth
Carriers
Contracting
Education & Training
Electronic Apps
Forms & Materials
Leads & Prospecting
Licensing Tools
Marketing Tools
Quoting Tools
Secure File Upload
Technology Help
Underwriting Factors
Medicare
Medicare Advantage
Medicare Supplement
Part D
Hybrid Life & LTC
Life & Annuities
Annuities
Final Expense
Life
Simplified Issue Term
Long-Term Care
Home Care
Short-term Care
Ancillary
Critical Illness
Dental, Vision & Hearing
Disability Insurance
Group Ancillary
Hospital Indemnity
Small Business Retirement Plans
Short-term Medical
Travel Insurance
News & Media
Incentives & Trips
Industry Links
Photo Library
Social Media
The Resource (Blog)
Tips of the Trade
Upcoming Events
Video Library
About Us
Contact Us
Find Out More (FAQs)
Meet the Team
Testimonials
Tools & Resources
Agent/Agency Profile
Business Growth
Carriers
Contracting
Education & Training
Electronic Apps
Forms & Materials
Leads & Prospecting
Licensing Tools
Marketing Tools
Quoting Tools
Secure File Upload
Technology Help
Underwriting Factors
Medicare
Medicare Advantage
Medicare Supplement
Part D
Hybrid Life & LTC
Life & Annuities
Annuities
Final Expense
Life
Simplified Issue Term
Long-Term Care
Home Care
Short-term Care
Ancillary
Critical Illness
Dental, Vision & Hearing
Disability Insurance
Group Ancillary
Hospital Indemnity
Small Business Retirement Plans
Short-term Medical
Travel Insurance
News & Media
Incentives & Trips
Industry Links
Photo Library
Social Media
The Resource (Blog)
Tips of the Trade
Upcoming Events
Video Library
About Us
Contact Us
Find Out More (FAQs)
Meet the Team
Testimonials
Client Information
*
Indicates required field
Name of Annuitant
*
First
Last
Name of Joint Annuitant
*
First
Last
Date of Birth
*
Date of Birth
*
Gender
*
Male
Female
Gender
*
Female
Male
U.S. Resident?
*
Yes
No
U.S. Citizen?
*
Yes
No
Resident Country (if not U.S.)
*
Coverage Details
Type of Annuity Requested
*
Qualified (Pre-tax)
Non-qualified (After-tax)
Single Premium Deferred
Deposit Amount
*
1035 Funds
*
Yes
No
Multi-year Guarantee
Number of Years
*
Maximum Surrender Charge Period (# of Years)
*
Indexed
Indexed Maximum Surrender Charge (# of Years)
*
Bonus
*
Yes
No
Single Premium Immediate
Deposit Amount
*
1035 Funds
*
Yes
No
Agent Information
Agent
*
Phone
*
Email
*
Agency
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Submit
