Annuity quote request
Broker information
Agent's name
Agent's MVP Contact
Please select...
Dawn Nelson
Matt LaLonde
Joe Carey
Fred Thorbahn
Jodi Waldera
Scott Thorp
Michael Zingale
Mary Lou Paul
Jim Chrisler
Other / None of the above
Agent's email address
Agent's cell phone
Annuitant information
Annuitant's name
Annuitant's date of birth
Annuitant's sex
Male
Female
Add a joint annuitant?
Yes
No
Joint annuitant's name
Joint annuitant's date of birth
Joint annuitant's sex
Male
Female
Annuity product
Type of annuity product
SPDA
MYGA
FIA
DIA
FPDA
SPIA
Other
To quote more than one product, click "Add another annuity product" at the bottom of this section.
Other type of annuity product?
State of issue
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
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
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Qualified or non-qualified?
Qualified
Non-Qualified
Inherited?
Yes
No
What type of account?
Traditional IRA
Roth IRA
Non-IRA Qualified
Deposit amount
$
Date of deposit
Is there a 1035?
Yes
No
Complete for MYGA
Number of guaranteed years
2
3
4
5
6
7
8
9
10
11+
Complete for SPIA
Payout frequency
Annual
Semi-annual
Quarterly
Monthly
Solve for
$
Date of initial payout
"Installment refund" or "Cash refund"?
Installment refund
Cash refund
Type
Please enter "Life Only" or "Life and # Years Certain" or "Year Certain Only/ # of Years"
What percent of income should continue to the 2nd life at time of 1st death?
100%
66%
50%
0%
Other
Other percent; please enter here
Quote impaired Risk SPIA?
Yes
No
Describe medical condition
Complete for FIA
Surrender period
4
5
6
7
8
9
10
11
12
13
14
Riders
Income Rider
Death Benefit Rider
Long Term Care Rider
MVA?
Yes
No
Flexible?
Yes
No
Premium bonus?
Yes
No
Bonus % (1-6%)
%
Required AM Best carrier rating (None, A+, A, A-, etc.)
Withdrawal type (1st year)
Interest only
5%
10%
15%
20%
Withdrawal type (2nd year)
Interest only
5%
10%
15%
20%
Additional information: Please list any additional comments or competition information that will assist us in properly preparing your quote.
Contact Information