BRENDANWOOD FINANCIAL BROKERAGE

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CONTACT

PHONE: 317.731.6509

FAX: (317) 731-6738

ADDRESS

11711 N. MERIDIAN STREET 
SUITE 225 
CARMEL, INDIANA, 46032

USA

HOURS: 9-5, M-F EST

©2019 BY BRENDANWOOD FINANCIAL BROKERAGE, LLC.

Annuity Quote Request

Agent Information​

Joint Annuitants?

Annuitant #1 Information​

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Annuitant #2 Information​

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Financial Profile & Plan Design

(Combine for Joint Annuitants)

Source of Income (Check All the Apply)

If Other was Selected, Please explain below

(Exclude Tangible Assets)

(Liquid Net Worth)

What type of investments and insurance products do they own?

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If Other was Selected, Please Explain Below

How long do they plan to keep their money in the annuity before drawing an income?

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Are they considering discontinuing making premium payments, surrendering, forfeiting, assigning to the insurer, or otherwise terminating an existing life insurance policy or annuity contract OR using monies from existing life insurance policies or annuity contracts to contribute to the new contract?

If Yes, how long has the policy or contract been in force?

If Yes, what is the surrender charge?

Plan Design

Death Benfit?

Confinement / LTC?

Qualified Finds?

Premium Type

At Least A Rated?

10/10 Compliant?