RetirementDepot.com
Fixed annuities and life insurance for individuals, groups and agents.
A domain of FSD Insurance Services.

Toll Free: 800-373-9697
Email: jeff@retirementdepot.com

 
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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:
 
Spouse Information (if any):

Name:     Male   Female
D.O.B:  Age:  
 
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 (must be within 30 days of today)

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 plus guaranteed refund period. 

Joint Lives - For as long as either of two are alive plus guaranteed refund period. 

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.
 

Annual Inflation Protection (COLA):

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

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.
Comments - Requests - Referred By:

 

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