Home Request for Proposals


If you would like to request a proposal, please fill out this form. This will give us the information we need to get started right away.

Username (If You Are Registered):
Password (If You Are Registered):
Name:
Address:
City:
State:
Zip Code:
Phone Number (Include Area Code):
() -
Fax Number (Include Area Code):
() -
E-mail Address:
@
Type of Product Requested:
If other, then what?
Company to beat:
(If you have a copy of the proposal, fax a copy to us)
Client Name:
Client Age:
Joint Applicant's Name:
Joint Applicant's Age:
State of Issue:

1. Annuities

Amount to Deposit:
Qualified or nonqualified?
Yes  
No  

For how many years (if applicable):
Immediate, Deferred or Split Annuity:
Withdrawals needed?
Yes  
No  
If so, when?
And for how much?
Features or benefits that the client is looking for that would "cinch the deal." In other words, what's their hot button?

2. Life Insurance

Amount of death benefit?
Permanent or Term?
Single or Joint Life?
Future Withdrawals?
Yes  
No  
1035 Exchange?
Yes  
No  
Amount:
Underwriting Information:
Smoker?
Yes  
No  
Preferred?
Yes  
No  
Standard?
Yes  
No  
Other?
Yes  
No  
If other, then what?

3. Long Term Care

Monthly Benefit:
Waiting Period:
Benefit Period:
COLA:
Yes  
No  
Other:
Comments:
 

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