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Home
Products
Product Information
Underwriting Guides
Quotes
Life Quotes
Quote Request
iGO/E-APP
Carrier Drop Tickets
Forms
Additional Forms
Contracting
My Cases
Contact Us
Annuity Quote REquest
*
Indicates required field
Agent/Agency:
*
Date:
*
Need By:
*
Email
*
Phone Number
*
Fax Number
*
Annuitant Initials Only
*
Sex
*
Male
Female
Date of Birth
*
Secondary Annuitant Initials Only
*
Sex
*
Male
Female
Date of Birth
*
Annuitant's State of Residence:
*
Illinois
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
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
Tax Qualification:
*
Qualified
Non-Qualified
IRA
Other
Type of Annuity to be Quoted
1. Single Premium Deferred Annuity (SPDA)
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Traditional fixed
Index
Deposit Amount
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Anticipated Date of Deposit
*
Surrender Period
*
Guaranteed Period
*
MVA:
*
Yes
No
2. Flexible Premium Deferred Annuity (FPDA)
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Traditional fixed
Index
Initial Deposit Amount
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Anticipated Date of 1st Deposit
*
Subsequent Deposit Amounts
*
Frequency:
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Monthly
Quarterly
Semi-Annual
Annual
Surrender Period
*
Guarantee Period
*
MVA:
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Yes
No
3. Immediate Annuity (SPIA) Deposit Amount
*
Anticipated Date of Deposit
*
Annuity Forms to Quote
Life Only
*
Check if Yes
Life With Years Certain
*
Check if Yes
How many years?
*
Joint & Percentage Survivor Life Only
*
Check if Yes
What percentage?
*
Joint & Percentage Survivor with Life And Certain Years
*
Check if Yes
What percentage?
*
How many years?
*
Other
*
Check if Yes
Details
*
Submit
