Quote Request Jan 31, 2015 We appreciate you taking the time to give us the necessary information to see how we may support you in achieving and exceeding your financial asset management and retirement planning goals! Let us know How we may Help! Insured's Date of Birth (Some financial products will keep you at your current age or may put you at your future age if past the 6th month from your birthday) Insured's Height (Used for life insurance sales only, not annuities) Insured's Weight (Used for life insurance sales only, not annuities) How would you rate your health? (Used for life insurance quote only--not for annuities) Very Healthy (Physically fit, no medications, good cholesterol and blood pressure)Healthy (Average to very physically fit, takes none or only a few medications, normal blood pressure & cholesterol)Less Than Healthy (less than average to bigger build, takes more than two medications, poor blood pressure or cholesterol)Poor Health (Overweight, takes multiple medications, health concerns or ongoing complications) Are you a tobacco user? Select Option From DropdownYesNo Do you currently own any existing life insurance or annuity contracts? Select Option From DropdownYesNo What is the current cash value in your existing life insurance or annuity contracts? (you can transfer cash values from life insurance or annuity contracts TAX-FREE to a newer better life insurance or annuity product through what's called a 1035 Exchange) Do you have an insurance product type(s) that specifically interests you? (leave blank if you have NO specific product in mind as we will help you pick the one that meets your needs) Indexed Universal Life Insurance (Living Benefits included!)Fixed Universal Life Insurance (Living Benefits included!)Term Life Insurance (Living Benefits included!)Whole Life Insurance (Living Benefits included!)Long-term Fixed Premium AnnuitySingle Premium Immediate Annuity (Fixed & Indexed w/ Guaranteed Income Rider & Enhanced Benefits)Single Premium Deferred Annuity (Fixed & Indexed w/ Guaranteed Income Rider & Enhanced Benefits) How will the insured be paying the premium? Another owned life insurance or annuity contract (1035 Tax-Free Exchange)An Individual Retirement Account (IRA)Income / SavingsCorporation or Other Business Entity Please check off all areas where you would like our support: Life InsuranceAnnuityRetirement PlanningTax-free Retirement StrategiesAsset Management and Financial Liability ProtectionCorporate & Executive / Key Employee Retirement & ProtectionEmployee Benefit & Retirement PlansSimple 401k, 412e3Small to Mid-Sized Business Protection, Benefit, and RetirementSeeking Tax Deductions or Qualified Accounts ConversionSocial Security Income & Tax PlanningCorporate & Small Business Fringe Benefits (Non-Qualified Plans) THINGS TO CONSIDER WHEN ASSESSING FINANCIAL PROTECTION NEEDS: At an easy glance you can calculate the minimum amount of financial protection needed. We call it the DIME approach: D = DEBT I = INCOME M = MORTGAGE E = EDUCATION Sum the values of each category to see what the minimum amount of financial protection is needed. How much debt do I have? (ie: Credit cards, mortgage, personal loan, etc.) If I were to pass away, how much money would my family need to survive? (Generally you want to protect 10 years’ worth of your income, ie: $35,000/annual income X 10 years=$350,000) How much is your mortgage? What is the mortgage term length? (ie: $250,000 mortgage for a 30 year term) How much money should I have set aside for the kids’ education? (ie: School may cost 40K per year for four years, which would be $160,000 for one child) TOTAL FOR FINANCIAL PROTECTION NEEDS (add all of the values above together to sum protection benefit needed): We finally add an "R" for retirement to make it the DIMER assessment: Please indicate below the amount of retirement income the insured needs to receive. Also indicate the age you would like to retire. On average, most clients are assuming retirement between the ages of 67-75 How much retirement income do I need? (ie: I need $3,000 per month, which is $36,000 per year,) At what age would you like to retire? Please type in below any further questions or comments you'd like to submit to us: Do you currently have a financial or retirement planner? Do you currently have a financial or retirement planner?YesNo
