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A Guaranteed Retirement Income Program for pension and qualified rollovers.
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GRIP Retirement Immediate Income Quote Requests
Client health factors? Click for underwritten - rated age income information!

Participant Information:
Name:    Male  Female
D.O.B.  Age:   State:

Joint (spouse) Participant Information (if any):
Name:     Male   Female
D.O.B:  Age:   State: 

Source of Funds:
Qualified (Ira, 401K rollover, Pension etc.)
 Non- Qualified (cash, 1035 exchange etc.)

Deposit Amount: $
Desired Income: $
1035 Cost Basis  $

Deposit Date: Month Day Year

Income Start: Month Day Year

Annuity Payment Frequency:
Monthly Semi-Annually Quarterly Annually

Type of Guaranteed Income Annuity: (Multiple selection are allowed)
SINGLE LIFE
Life Only
Life with period certain of:
      5 Year 10 Years 15 Years 20 Years 
      Specific: and   Months
 Life With Installment Refund 
Life With Cash Refund (low availability on cash refunds, not offered by many companies)

Joint Lives
 Joint & Survivor Lives ONLY
Joint with period certain of:
    5 Year 10 Years 15 Years 20 Years   
    Specific: and  
Joint Percent
Reduce on primary (default)
Reduce on either

Period Certain ONLY
   Period Certain Only for:
5 Year 10 Years 15 Years 20 Years
 Specific:   Years and Months

Annual Increases:

Requested By:

Company You Work For:

Who is your company's plan provider: 

Email: required

Phone: Appreciated

Fax: If you would like quotes faxed

Receive quotes by:
Email Adobe Acrobat PDF  
Email Text
 Fax 
Phone Call  
HTML Email Link

Please use this section for any special requests that do not appear on the form.
Comments - Requests - Referred By:

 

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Copyright © 2005 GRIP Retirement LLC
Last modified: 04/08/08