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AEP
Contracting
Existing Agents
Licensing Tools
New Agents
Products
Ancillary
>
Disability Insurance
Group Ancillary
Hospital Indemnity
Small Business Retirement Plans
Short-term Medical
Travel Insurance
Critical Illness
Dental, Vision & Hearing
Hybrid Life & LTC
Life & Annuities
>
Annuities
Term Life
Whole Life
LTC & Care Products
>
Long-Term Care
Home Care
Short-term Care
Medicare
>
Medicare Advantage
Medicare Supplement
Part D
Carriers
Carrier Selection
Forms & Materials
Incentives & Trips
Webinars
Quoting & Apps
Electronic Apps
iGo e-App
Medicare Center
Quote Requests
Quoting Tools
Underwriting
Marketing
Brochures
Email & Mail
Fact Sheets
Leads & Prospecting
Logos
Seminars & Webinars
Social Media
Websites
Tools & Training
Education & Training
Medicare Live
Secure File Upload
Tips of the Trade
Video Conference
News
COVID19
Industry Resources
The Resource (Blog)
About
Contact
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
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City
*
State
*
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