Skip to content
800 Shades Creek Parkway, Suite 525 Birmingham, AL 35209
info@lesourdpartners.com
Member of the Advantage Insurance Network
Menu
Meet LeSourd Partners
Get In Touch
Advisor Login
Close Menu
Annuity Quote REQUEST
Broker Information
Agent Name
*
First
Last
Phone
*
Email
*
Client
Annuitant
Name
*
First
Last
Birthdate
*
MM slash DD slash YYYY
Gender
*
Male
Female
Joint Annuitant
Name
First
Last
Birthdate
MM slash DD slash YYYY
Gender
Male
Female
Annuity
Insurance Company Preference, if any
State of Issue
*
Tax Qualified
*
Yes
No
Annuity Type
*
Choose One
Deferred Annuity
Immediate Annuity
Additional Information
Please list any additional comments or competition information that will assist us in properly preparing your quote.
Δ