Request Individual Annuity Quote Your contact information Please note that all contact fields are required. First Name: Last Name: Email: Telephone: Today's Date: How did you hear about us? Annuity Specifications Please complete all fields for accurate quotes. Annuitant Name: Annuitant Last Name: Annuitant Gender: Annuitant DOB: Co-Annuitant Name: Co-Annuitant Last Name: Required Co-Annuitant Gender: Required Co-Annuitant DOB: Required Co-Annuitant Relationship: Monthly Benefit / Account Balance: Benefit Start Date: Benefit Forms (Select as many as the plan provides for) Life Only Life with Cash Refund Life with 5 Years Certain Life with 10 Years Certain Life with 15 Years Certain Life with 20 Years Certain Joint and 50% Survivor Joint and 67% Survivor Joint and 75% Survivor Joint and 100% Survivor Required 50%, 67% or 75% Joint and Survivor Forms to Reduce on Death of Annuitant Co-Annuitant Either Death Special Provisions: Type of Funds: Employer Purchased / Owned Employer Purchased / Employee Owned Employee Purchased / Employee Owned State of Residence: Plan's State of Jurisdiction: Plan or Plan Sponsor Name: Send Reset DB Plan Consultation Individual Annuity Quote