ICA Annuity Quote Request

Thank you for the opportunity to support you and your client! The more details you provide, the better we can customize your solution. Once complete, click Submit—your information will remain confidential and be sent directly to our team.

Advisor Name

First NameLast Name

Advisor Email Address

example@example.com

Advisor Phone Number

Area CodePhone Number

Client Name

First NameLast Name

Client DOB or Age

Client Gender

Client Residence State

State where application will be taken. (If different than residence state.)

Is this design going to be "Joint" or "Individual"?

If Joint: Spouse/Partner's Name

First NameLast Name

Spouse/Partner's DOB

Approximate amount of investment:

Will funds come from a qualified or non-qualified account?

What type of account are the funds currently invested?

How are the funds currently invested?

Will the funds come from another annuity?

If yes, are there surrender charges? Please include details like surrender charge, remaining schedule, etc.

Income needs from annuity:

If this is Joint, Will joint income be needed?

If applicable, what is the age the client will take income?

What type of products/compensation do you prefer?

What type of products/solutions do you prefer

Do you have a preferred carrier(s)?

All Fixed and Fixed Index Annuities we offer provide tax deferral and principal protection. Please select other features that would be attractive to you:

When are you meeting with your clients?

Date

(Optional)- Did you know we have a comprehensive offering? Please check the ideas that you would be open to learning more about.

Notes/Additional Information

ICA Insurance Services is supported by Lockton Affinity, LLC d/b/a Lockton Affinity Insurance Brokers LLC in California (#0795478). Lockton Affinity provides access to insurance and annuity solutions, as well as sales and case management support to ICA Insurance Services.

ICA Insurance Services and Lockton Affinity are not affiliated companies.