Annuity Online Investment Form  

It's safe and easy


You can start in any of three ways:
1) Online: Complete this form and click "Submit Application" button at the bottom
2) Fax: Print this form, complete with a pen, and fax to 817-924-3485
3) Telephone: Call the toll-free number. We will help you.

Three Easy Steps

Step 1:  Select a CD-type annuity that meets you needs. Use the list of annuities to find one that has the guaranteed term, interest rate, and other features which suits you. If you have questions about a annuity, just call the toll-free number or click "Ask" to submit questions online.

Step 2: Order the paperwork. You can order online, via fax, or by phone. Paperwork (completed to your specifications) will then arrive at you home the next day by overnight delivery.

Step 3:  Forward the paperwork and your check directly to the financial institution. You will not return the paperwork to us. Instructions and prepaid delivery will be provided for you to forward your paperwork and check directly to the financial institution offering the annuity.

With most financial institutions, your annuity will arrive at your home within 30 to 45 days.

Help is always available to you
 During the process, our staff will be in contact with the financial institution.  We will monitor the progress of your annuity investment to make sure it is handled in a timely and efficient manner. If you have questions or want a update on the status of your investment, simply call us.  We will provide any help and support you need.

Because our staff is extremely busy helping others, we respectfully request that only those who are ready to move forward submit the form.

If you have questions or need help, you can call us at 1-800-747-7384.

  
 
  Name of Annuity:    
Guarantee Period:   Years
       
  Owner  
Email
Full Name 
Gender  Male   Female
Date of Birth  , 19
Street Address 
City 
State 
Zip Code 
Phone Number   » Why?
   
  Joint Owner     (Note: IRA's cannot have a Joint Owner)  
No Joint Owner
Full Name 
Gender  Male   Female
Date of Birth  , 19
Street Address 
City 
State 
Zip Code 
   
  Annuitant  
Same as Owner
Full Name 
Gender  Male   Female
Date of Birth  , 19
Street Address 
City 
State 
Zip Code 
   
  Joint Annuitant  
Same as Joint Owner
Full Name 
Gender  Male   Female
Date of Birth  , 19
Street Address 
City 
State 
Zip Code 
   
  Beneficiaries  
  Full Name                     Relationship                     %
Beneficiary 1
Beneficiary 2
Beneficiary 3
  Additional 
Beneficiaries' 
Information 		  
       
  Contingent Beneficiaries  (Annuity goes to these people if Primary Beneficiaries are deceased.)  
  Full Name                      Relationship                     %
Contingent 1
Contingent 2
Contingent 3
Additional 
Beneficiaries' 
Information 
   
  Information About the CD-Type Annuity  
Is your money from a retirement account or not?
  A retirement account of some type such as an IRA (Qualified)
Roth IRA   403(B)
Traditional IRA 401(K)
SEP IRA Other type of retirement account:
A non-retirement account (Non Qualified)
A regular account - not a retirement account
 
Will you be investing with a check or will this be a transfer?
  Check. I'm sending a check with the paperwork in the amount of $
Transfer.  I would like to transfer the money. (e.g. from a bank, insurance company, etc.)
  Company Name
Street Address
City
State
Zip Code
Account Number
Approximate amount to be transferred?   $
Is this a full or partial transfer of the account?   Full
Partial
 
Do you plan on taking withdrawals from this investment?
  No.  I want it to reinvest.
Not immediately, but I may want withdrawals in approximately years.
Yes.  I want to take withdrawals immediately.
  Interest only
10% of the investment annually
Other
 
Would you like your form reviewed before your paperwork is sent to you to make sure it is completed correctly?
  Yes
    No  
     
Do you have any questions about the CD-type annuity that you are applying for? Or is there anything else we can do to make your investment experience even better?