Annuity Quote Request Form
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Annuity Type:
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CD Type
Fixed Annuity
Equity Index Annuity
Immediate Annuity
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What is your investment objective?
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CD Alternative
Automobile
College Savings
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Long Term Growth
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Save for Retirement
Second Home
Other-(Please explain in comments)
Dollar amount of your estimated initial investment?
$10,000
$25,000
$50,000
$100,000
$200,000
$250,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
$1,500,000
What is your time frame for this investment?
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1 year
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Where is this investment currently?
Select Fund Source
401K Distribution
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-------------
CD
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What is the current rate of return you are receiving on these funds?
Will you be making periodic investments to the above amount?
Yes
No If yes, enter amount and Frequency :
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None
$50
$100
$150
$200
$250
$500
$750
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
$12,500
$15,000
$17,500
$20,000
$22,500
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
Select
None
Monthly
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Will this Annuity replace or change existing Annuities or Life Insurance?
Yes
No
If yes, please give reason for replacement:
Desired annual income to be generated by this investment:
Select
$10,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
Who will this quote be for:
Self
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Marital Status:
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Single, one dependent
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