Immediate Annuity Quote Request Form


Use this form for guaranteed income quotes or call 800-373-9697 for assistance.
Owner Information:

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

Name:
    Male   Female
D.O.B:
 Age:  
Spouse:
 
Source and Amount of Premium:

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

Premium Amount: $
OR
Desired Income Amount: $
 

Timing

Deposit Date:
Month Day Year

Income Start: Month Day Year

Annuity Payment Frequency:
Monthly
Semi-Annually
Quarterly
Annually
 

What Type of Income Annuity Do You Want
We will quote several options including full refund based on the benefit you choose.

Single Life - For as long as one is alive. 

Joint Lives - For as long as either of two are alive. 

Period Certain ONLY - Not based on any life for just a specific guaranteed period.

Not sure what to choose, feel free to use the box below to simply tell is what you are looking for.
Or Call 800-373-9697
 

Annual Inflation Protection (COLA):

Email:   required
Phone: Appreciated
Fax: If you would like quotes faxed

VALIDATE: ENTER THE WORD service  

Receive quotes by:
Email Adobe Acrobat PDF   Email Text
Fax Phone Call

Please use the comment for any special requests that do not appear on the form.
Requests - Referred By:

 

 

Call toll-free: 800-373-9697


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Managing general agency is FSD Financial Services
CA Insurance License #
0B67385

Non Resident Licenses as of 05/04/2017: 
AL, AZ, CO, FL, HI, GA, ID, IL, IA, KS, LA, MD, MI, MO, NV, NJ,
 NY, OH, OK, OR, PA, TN, TX, UT, VA, WA