Rasberry Agency, Ltd.
   Login

Life, Annuities, LTC, Life and Annuity Settlement
    
    
    
    
    
    
    

"If a man doesn't believe in life insurance, let him die once without it. That will teach him a lesson." - Will Rogers

* Full Name of Agent
Address Line 1
Address Line 2
City, State, Zip
* E-Mail
* Business Phone
Cell Phone
Home Number
Fax Number

Annuitants Name:
Annuitants Date of Birth:
Annuitants Sex:
Male
Female

Joint Annuitants Name
Joint Annuitants Date of Birth:
Joint Annuitants Sex:
Male
Female


State
Amount of premium available:
What is the premium
Qualified
Non-Qualified
How often will the income need to be paid?
Annual
Semi-Annual
Quarterly
Monthly
These income payments would need to begin when?
Choose the payout method
X yr certain
Life only - no refund or uncertain period
Life with X yr certain
Life with installment refund
Joint and survivor 100%
Joint and survivor 75% reduced at either death
Joint and survivor 67% reduced at either death
Joint and survivor 50% reduced at either death
Joint and survivor 75% reduced at primary's death
Joint and survivor 50% reduced at primary's death
Joint and survivor 100% with X yr certain
Joint and survivor 100% with cash refund
Years certain(X from above):
When will funds be available for this case?

Are you in competition for this case?
Yes
No
I don't know
If yes, please specify
Any additional comments?
Home   |   Forms   |   Quotes   |   Annuities   |   Tools   |   Contact Us  
Copyright © 2005 Rasberry Agency LTD. All Rights Reserved. Portions Copyright © 2005 BISG, Inc