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 Immediate Annuities - Single Premium Immediate Annuities, SPIA's Guarantee Income.
Guaranteed retirement income for life!

 
Please fill in as much information as possible.
Annuitant Information:
Name:   
Male  Female
D.O.B.  Age:   State:

Joint Annuitant Information (if any):
 Name:    
Male   Female
D.O.B:  Age:   State: 

Source of Funds:
 Non- Qualified (cash, 1035 exchange etc.)
Qualified (Ira, 401K rollover, Pension etc.)

Deposit Amount: $
Desired Income: $
    1035 Cost Basis  $

Deposit Date: Month Day Year

Income Start: Month Day Year

Income Payment Frequency:
Monthly Semi-Annually Quarterly Annually

Type of Immediate Annuity:
 SINGLE LIFE
Life Only
Life With period certain of:
      5 Year 10 Years 15 Years 20 Years 
      Other: Years and   Months
 Life With Installment Refund 
Life With Cash Refund (low availability / none joint lives)

JOINT LIVES
Joint & Survivor Lives ONLY
Joint With period certain of:
    5 Year 10 Years 15 Years 20 Years   
    Other: Years and   Months
Joint Percent To Survivor

Period Certain ONLY
   Period Certain Only for:
5 Year 10 Years 15 Years 20 Years
 Other:   Years and Months

Annual Inflation COLA:

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