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ANNUITY QUOTE REQUEST
Complete the following information if you would like to obtain an Annuity quote. Please understand this is not an application. An application will be sent to you if coverage is desired.
All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.
Personal Information
What is your name?
Last
First
Middle
What is your e-mail address?
e-mail
What state do you reside in?
State
What is your tax bracket?
Tax Rate
What is your telephone number?
Telephone
What is your fax number?
Fax
What is your birth date?
Birth Date
What is your gender?
Gender
Male Female
When do you plan to retire?
Anticipated Retirement Age
(example 65)
Interest in this Annuity?
Who is it for?
Yourself
Relative
Friend
Employee
Is the money being deposited Qualified Funds?
(Are you bringing them over from an IRA, SEP, Keogh, Pension, or 401(k)?
Yes No
Terms
What terms would you prefer for your quote?
A monthly income that pays out for the lifetime of the annuitant, no matter how long the annuitant lives.
This will generate the maximum monthly payout.

A monthly income that pays out for the lifetime of the annuitant, and at least 10 years certain no matter how long the annuitant lives.
This will generate less than the maximum monthly payout.

A monthly income that pays out for the lifetime of the annuitant, and at least 20 years certain no matter how long the annuitant lives.
This will generate even less then the plan above.
To request a quote, make one selection, fill in the amount for that selection, then click on the submit button. For additional quotes, repeat the procedure.
Annuity Quote based on an amount deposited
Single Premium Immediate Annuity Monthly payments starting in 30 days from now Lump Sum Deposit
Deferred Annuity Monthly payments starting at the anticipated retirement age Make a
Lump Sum Deposit (one)
or
Monthly Deposits
(continuing until retirement age)

Amount of one Deposit:
Equity Indexed Annuity Monthly payments starting at the anticipated retirement age Make a
Lump Sum Deposit (one)
or
Monthly Deposits
(continuing until retirement age)

Amount of one Deposit:
Quote based on monthly income needed
Desired Monthly Income Amount
Single Premium Immediate Annuity
Lump Sum Deposit required for monthly income starting in 30 days
 
Flexible Premium Deferred Annuity
Lump Sum Deposit required for desired monthly income to start at the anticipated retirement age.

Monthly Deposits required for desired monthly income to start at the anticipated retirement age.
Equity Indexed Annuity
Lump Sum Deposit required for desired monthly income to start at the anticipated retirement age.

Monthly Deposits required for desired monthly income to start at the anticipated retirement age.
Best Time to Contact You
Please let us know the best time to call and discuss your quote.
Morning
Afternoon
Evening
Anytime
Or specify other:
     
 
A/R Financial Group

9950 Westpark ste.290 | Houston, TX 77063
Phone 281-206-0066
Fax 713-893-6003
 
 
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