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Advisor quote request

Annuity Quote Request

SPIA, deferred income, MYGA, fixed indexed and income rider illustrations for qualified and non-qualified money.

Two ways to send it: fill out the form below online, or download the PDF, complete it and upload it here or email it to tjfuller@srsinc.com.

↓ Annuity quote request (PDF)↓ Annuity request with asset information (PDF)Submit online ↓

Submit online

Annuity Quote Request

Advisor information

Advisor name(Required)

Annuitant information

Annuitant name(Required)
MM slash DD slash YYYY
Annuitant gender(Required)
Joint annuitant name (if any)
MM slash DD slash YYYY
Joint annuitant gender

Annuity design

Tax qualified?(Required)
Annuity type
Design
Fixed annuity term (years)
Source of funds

Asset information

Optional. Helps us recommend the right design.

Monthly income

Gross monthly amounts.

Upload or notes

Drop files here or
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 10 MB, Max. files: 3.
    PDF, Word or image files. Up to 3 files, 10 MB each.

    What happens next

    We review the request, shop the carriers that fit, and respond within 1 business day. You will get an email confirmation as soon as you submit.

    Include statements for existing annuities or accounts being moved, and we will compare surrender values and options.

    Other quote requests

    Questions? Call 303-309-3471.