Complete the following information
if you would like to obtain an Annuity quote. Please understand
this is not an application. An application will be sent to you if
coverage is desired.All information provided on this information
sheet is confidential and will be used solely for the purpose of
developing a quote for you.
Personal Information
What is your name?
Last
First
Middle
What is your e-mail address?
e-mail
What state do you reside in?
State
Select
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Washington, DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
What is your tax bracket?
Tax Rate
What is your telephone number?
Telephone
What is your fax number?
What is your birth date?
What is your gender?
Gender
When do you plan to retire?
Anticipated Retirement Age
Interest in this Annuity?
Who is it for?
Is the money being deposited Qualified
Funds?
(Are you bringing them over from an IRA, SEP,
Keogh, Pension, or 401(k)?
Terms
What terms would you
prefer for your quote?
This will generate the maximum monthly
payout.
10 years certain no matter
how long the annuitant lives.
This will generate less than the
maximum monthly payout.
A monthly income that pays out for the lifetime
of the annuitant, and at least 20 years certain
no matter how long the annuitant lives.
This will generate even less then
the plan above.
To request a quote, make one
selection, fill in the amount for that selection, then click on
the submit button. For additional quotes, repeat the procedure.
Annuity Quote based on an
amount deposited
Single Premium Immediate Annuity
Monthly payments starting
in 30 days from now
Deferred Annuity
Monthly payments starting
at the anticipated retirement age
Make a
Equity Indexed Annuity
Monthly payments starting
at the anticipated retirement age
Make a
Quote based on monthly income
needed
Desired Monthly Income
Amount
Single Premium Immediate Annuity
Lump Sum Deposit required
for monthly income starting in 30 days
Flexible Premium Deferred Annuity
Lump Sum Deposit required for
desired monthly income to start at the anticipated retirement age.
Monthly Deposits required for
desired monthly income to start at the anticipated retirement age.
Equity Indexed Annuity
Lump Sum Deposit required for
desired monthly income to start at the anticipated retirement age.
Monthly Deposits required for
desired monthly income to start at the anticipated retirement age.
Best Time to Contact You
Please let us know the best time to call and discuss your quote.
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