FFM - Free Varible Annuity CD Request Form

Free Variable Annuity CD Request Form

Please complete the following confidential request form to receive your FREE CD. Please note: All fields must be completed.

The CD is an easy-to-navigate program providing information on one of the country's Variable Annuity providers. It will explore everything from what annuity is and does to interviews with the managers and their investment styles and philosophies.

Whether your are a seasoned VA investor or just beginning to learn the ropes, you will enjoy exploring this CD.

  Name:         
  Address:    
  City:         State/Province: 
  Zip Code:   
  Email:      
  Home Phone:   
  Work Phone: 

  I consider myself a:
     Aggressive Investor    Moderate Investor   
     Conservative           Willing to accept NO risk  
  
  Do you currently own an annuity?           Yes   No
  
  Are you looking to upgrade this annuity?    Yes   No
  
  Are you a mutual fund investor?
     Yes   No
    
  Your age is:
     25-35    35-45    45-55    55-65   65-Above
    
  Your tax bracket is:
     28%    31%    36%    39.6%    Unknown
  
  Amount you may want to consider investing: 
     Single    Quarterly    Semi-Annually    Annually

  Your goal is:
     Tax Deferred Growth    Capital Preservation   
  
  Your estimated time frame to purchase an annuity plan is:
     Less than one month    1 to 3 months    3 to 6 months

  Your general awareness on this subject is:

  Are you a Financial Advisor? (RIA, stockbroker, insurance agent, fee planner):
     

  Additional Comments/Questions:

Securities are offered through Girard Securities, Inc. member FINRA, SIPC.
Mark R. Fielder, Registered Principal. CA. Insurance Lic. # 0690576.