Immediate Annuity Quotes For Agents

Annuitant Information:

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

    Male   Female
 Age:   State: 
Source of Funds:

Non- Qualified (cash, 1035 exchange so on)
Qualified (Ira, 401K rollover, Pension so on)

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


Deposit Date:
Month Day Year

Income Start: Month Day Year

Annuity Payment Frequency:
Monthly Semi-Annually Quarterly Annually

Medical Underwriting?
Poor health client? Should try an impaired risk quote.

Type of Immediate Annuity:


Life Only
Life With period certain of:
5 Year 10 Years 15 Years 20 Years 

Life With Installment Refund 
Life With Cash Refund

Joint LIFE
Joint & Survivor Lives ONLY
Joint With period certain of:
    5 Year 10 Years 15 Years 20 Years

Joint Percent To Survivor

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


Annual Inflation COLA:

How Should We Send The Quotes:

Agent Email:
Phone: Appreciated
Signing Agent: required
Requested by: (If other than agent)

Receive quote BY:
Email Adobe Acrobat PDF
Email Text
Phone Call

Please use the agent comment for any special requests that do not appear on the form.
Agent Comments - Requests:

Send mail to with questions or comments about this web site.

A domain of FSD Financial Services - CA Insurance License # 0B67385 and 0B91910
Copyright 2017 - Last modified: 04/21/2017 -

Terms Of Use

Earnings and pre-tax premium payments are subject to income tax at withdrawal. Withdrawals prior to age 59 are generally subject to a 10% IRS penalty tax. FSD Financial Services does not offer tax advice. For specific tax information, consult your attorney or tax advisor. Product and feature availability, as well as benefit provisions can vary by state.