Annuity Quote | Standard Marketing

Annuity Quote Request Form

Fill out the following fields to request an annuity quote. A number of fields are required, this is marked by an asterik (*) beside the field's title. Your quote cannot be completed if you do not complete the required components.

Agent Information

Agent/Broker Name: *

Address 1: *

Address 2:

City: *

State: *

Zip:

Phone Number: *

Fax Number:

Email Address: *

Return Method: *

Fax

Broker Pick-Up

Mail

Client Information

Annuitant Name: *

Annuitant Birthday: *

Annuitant Gender: *

Join Annuitant Name:

Join Annuitant Birthdate:

Join Annuitant Gender:

Annuity Information

Insurance Company Preference if any:

State of Issue: *

Tax Qualified?: *

Select an Annuity Product:

Single Premium Deferred

Flexible Premium Deferred

Single Premium Immediate

Single Premium Deferred Deposit Amount:

Flexible Premium Deposit Amount:

Single Premium Immediate Deposit Amount:

Benefit Mode:

Date of Deposit:

Date of Initial Benefit:

Type of Benefit:

If Period Certain, How many years:

Quote Impaired Risk SPIA:

Describe Medical Conditions:

Additional Information:

Please list any additional comments or competition information that will assist us in properly preparing your quote.

Primary links

User login