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From: Kestler Financial Group
Subject: Request-a-Quote
Date: Wed, 23 Apr 2003 09:08:06 -0500 (CST)

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Request an Annuity Illustration!


We know your time is valuable.  We also know you're extremely busy.  So, we have made it easy for you.  Simply fill out the annuity request form below and you'll be receiving competitive quotes across your fax machine in minutes.   In addition, please feel free to give us a call at 800-699-0299.

1. Your client's name?

2. Gender?

3. Date of Birth or Age?

4. In which state will the application be taken?

5. Amount of money to invest?

6. What type of deposit?
Single DepositAnnuallyQuarterlyMonthlyWeekly

7. Is this Qualified or Non-Qualified Money?

8. Money is earmarked for:
RetirementImmediate IncomePass to HeirsFuneral ExpenseOther

9. If you would like to show an income, at what age should it start?

10. If showing an income stream, how long should it last?
Life OnlyLife and Ten Years GuaranteedLife and Twenty Years GuaranteedPeriod Certain for Ten YearsInterest Only

11. Additional comments or notes that may be needed to run the illustration:

12. Agent's Name? (For the Illustration)

13. Agents Phone Number? (For the Illustration)

14. Agents fax number? (Where you would like the illustration to be faxed)

If you do not receive a confirmation page after clicking submit, please click here.

Click on the this icon to send to another agent.

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