Contracting
Existing Agents
Find Out More (FAQs)
Licensing Tools
New Agents
Products & Carriers
Carrier Selection
Forms & Supplies
Incentives & Trips
Quoting & Apps
Electronic Apps
Medicare Center
Quoting Tools
Underwriting
Sales & Marketing
Brochures
Email & Mailers
Leads & Prospecting
Logo Design
Marketing Program
Product Fact Sheets
Seminars & Webinars
Social Media
Websites
>
Website Quoting Widget
Website Review
Tools & Training
Education & Training
Medicare Live
Referral Program
Secure File Upload
Tips of the Trade
Video Conference
Webinars
Contact
Meet the Team
Our Story
Photo Library
Testimonials
News
Agent Spotlight
COVID19
Industry Events
Industry Resources
The Resource (Blog)
Contracting
Existing Agents
Find Out More (FAQs)
Licensing Tools
New Agents
Products & Carriers
Carrier Selection
Forms & Supplies
Incentives & Trips
Quoting & Apps
Electronic Apps
Medicare Center
Quoting Tools
Underwriting
Sales & Marketing
Brochures
Email & Mailers
Leads & Prospecting
Logo Design
Marketing Program
Product Fact Sheets
Seminars & Webinars
Social Media
Websites
>
Website Quoting Widget
Website Review
Tools & Training
Education & Training
Medicare Live
Referral Program
Secure File Upload
Tips of the Trade
Video Conference
Webinars
Contact
Meet the Team
Our Story
Photo Library
Testimonials
News
Agent Spotlight
COVID19
Industry Events
Industry Resources
The Resource (Blog)
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
