Basic information needed to determine if an annuity is right for you.
Full Name *
Date of Birth *
Email Address *
Phone Number
Marital Status * MarriedSingleWidowed
Employed or Retired * —Please choose an option—EmployedRetired
Spouses Name (if applicable)
Spouses Date of Birth (if applicable)
Number of Children (if applicable)
Gross Monthly Income *
Monthly Household Expenses *
Approximate Net Worth *
Total Liquid Assets *
Have you ever owned an annuity?YesNo
Your Objectives (select all that apply) Preservation / Safety of PrincipalGuaranteed Lifetime IncomeHigher ReturnsReduce Stock Market RiskIncome Tax DeferralGrowth PotentialWealth TransferProbate AvoidanceBetter Interest Rates
General Risk Tolerance (select one) Conservative (low risk)Moderate (some risk)Aggressive (high risk)
Retirement Concerns (select all that apply) Stock Market VolatilityOutliving Your AssetsMedical / Nursing Home ExpensesInflation / Purchase Power
