Skip to content
Advisor Login
Register
Menu
Home
The CPS Advantage
Resources
Life Quotes
LTC Quotes
DI Quotes
Annuity Quotes
Life Insurance Policy Valuation
Recommended Insurers
Contracting
Pre-Appointment Carriers and States
Tom Lipscomb
Let’s Start a Conversation
About
The CPS Advantage
Marketing Team
Request Call or Zoom
Opportunities and Freedom
Close Menu
Annuity Quote Request Form
"
*
" indicates required fields
Financial Advisor Name
*
First
Last
Email
*
Phone
*
By when do you need the illustration / proposal?
Email address(es) for others who should be cc'ed with our reply:
Allowed to Sell Indexed Annuities?
Yes
No
Broker/Dealer:
ANNUITANT INFORMATION
Annuitant Name
First
Last
Date of Birth
Gender
Male
Female
State of Residence
ANNUITY DESIGN
Premium Amount
Tax Qualified
Yes
No
Annuity Type
Single Premium Immediate Annuity (SPIA)
Deferred Income Annuity (DIA)
Design
Fixed
Indexed
Fixed Annuity Term (Years)
3
4
5
6
7
8
9
10
SPIA Payment Option
Index Income Rider? When to start?
Additional comments or competitive information:
Δ
