The Hanks Group - Annuity Quote

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Annuity Quote

Form:Annuity Quote Request

Annuity Quote Request

Contact Information

Contact Name:
Address:
City:	State: Zip:
Daytime Phone:	Evenine Phone:
Contact Email Address:

Information

Name of your current insurance company:
How long have you been insured with that company?
Your Date of Birth: mm/dd/yy	Gender:
Flexible Premium (Deferred)	Deposit Amount: $
Single Premium (Deferred)	Deposit Amount: $
Flexible Premium (Immediate)	Deposit Amount: $
Equity Index (Single Premium)	Deposit Amount: $
Equity Index (Flexible Premium)	Deposit Amount: $

Investment Money Available:

Marital Status:

Additional Comments

Please give any additional comments or questions

No coverage of any kind is bound or implied by submitting information via this online form

Information from you and other sources, such as your driving, claims and insurance histories, may be used to calculate an accurate price for your insurance.
We will not distribute information to other parties other than for insurance underwriting purposes.
By submitting this form, you agree to release us from any liability should this information be accidentally viewed by others.

Enter the security code you see above. Code is NOT case sensitive.*

The Hanks Group
8238 E. RL Thornton Fwy Suite D
Dallas, TX 75228

Toll Free: 877-275-8372
Phone: 214-275-8372 fax: 214-275-8375
email: info@hanksgroup.com

� Copyright 2006
IMPORTANT NOTE: descriptions of insurance coverage on this web site are for informational purposes only and may not apply, or be included on your policy. Please contact us to confirm coverage provided on your insurance policy or policies your are contemplating purchasing. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.
READ OUR PRIVACY STATEMENT

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