If you have done enough research and you are ready to see what an IUL policy could look like for you, complete the questionnaire below to get a quote. The more honest and detailed information you are comfortable with sharing, the better chance we have of giving you an accurate quote. All information shared here is confidential and will not be shared with anyone other than our in house IUL quote team. There is no judgement on our end! Think of our team and your personal private shoppers. It is our job to do the shopping for you and help find you the best life insurance company and IUL policy to apply for based on the details provided here.

Upon completion of this questionnaire you will be directed to book a Zoom appointment with Amanda to review your IUL quote. Due to the complexity of the illustrations, we are not permitted to email them out to potential clients in advance. We look forward to working with you and guiding you to find the best IUL product to fit your goals.

Full Name *

Email *

Phone *

What US state do you live in? *

Date of birth *

Current Height and Weight *

What do you do for work? *

What do you want the main purpose of your IUL to be? (Check all that apply) *

Grow cash value for use 10+ years from now

Grow cash value to supplement my retirement income tax free

Infinite banking (immediate access to cash value to make a large purchase or investment)

Grow cash value to fund my child’s college/future

For permanent life insurance and long term care

Other

How would you want to save money in your IUL? *

How much would you want to get started saving per month or per year? *

What’s the most you could see yourself ever saving into this account within the next 3 to 5 years? *

How quickly would you want access to your cash value? *

Are you looking for a certain amount of life insurance? *

What is your annual household income (you + spouse)? *

In the past 10 years have you been convicted of a felony, misdemeanor, or been on probation or parole? If yes, please list the details below. *

In the past 5 years have you had your license revoked or suspended? If yes, please list the details below. *

Health Questions - Please be honest and truthful in your answers. The more details you can provide, the more accurate of an illustration we can create for you!

Do you have a history of any pre-existing medical conditions such as; high blood pressure, high cholesterol, diabetes, heart attack, seizures, stroke, epilepsy, kidney stones, arthritis, hyper/hypo thyroid, cancer, tumors, polyps, cysts, etc? If yes, please list the conditions below. *

Do you have a history of any mental or emotional condition or disorder such as; anxiety, depression, bipolar, schizophrenia, suicide attempt, etc? If yes, please list the conditions below. *

Do you have any history of substance abuse? If yes, please list the details below. *

Have you had any surgeries in the past 10 years? If yes, please list the details below. *

Terms & Conditions I agree to receive text messages at the above-mentioned phone number with confirmation of my appointment. I have permission to receive text messages about updates and newsletters; data charges may apply; reply STOP to opt out.

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