Term Insurance   Whole Life Ins.   Universal Life   Survivor Life   Mortgage Protection   Annuities   Pensions/401K   Key Man Coverage   Burial Insurance   Long Term Care   Medicare Supplements       Save Up To 70% On Your Insurance!   "Your One Stop Financial Warehouse Where We Do All the Shopping!"   Pension/401K Quote Form (Take less than 2 minutes to complete) Get Free Quotes First Name: Last Name: Date of Birth: (example: 06-04-64) Gender: Select Male Female Address City: State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Zip Code: Day Phone: Best time to call: Choose Time 7 A.M. to 9 A.M. 9 A.M. to 11 A.M. 11 A.M. to 1 P.M. 1 P.M. to 3 P.M. 3 P.M. to 5 P.M. 5 P.M. to 7 P.M. 7 P.M. to 9 P.M. 9 P.M. to 11 P.M. Evening Phone: Best time to call: Choose Time 7 A.M. to 9 A.M. 9 A.M. to 11 A.M. 11 A.M. to 1 P.M. 1 P.M. to 3 P.M. 3 P.M. to 5 P.M. 5 P.M. to 7 P.M. 7 P.M. to 9 P.M. 9 P.M. to 11 P.M. Email Address: Who is this quote for? Me Spouse Parent Child Partner Business Assoc. Other Tax Bracket: 15% 28% 31% 36% 39.6% other Amount of money you want to invest: (note $5,000 is a typical minimum) $ Ideally, Amount of money you want to have as a monthly pension payment: $ How often will you deposit additional funds? Monthly Quarterly Semi-annually Annually Primary consideration influencing your pension plan purchase: (leave blank if irrelevant) Tax-deferral of Salary No Company Pension Additional Retirement Benefits Better Retirement Planning How long would you like your pension to grow before receiving income payments? (leave blank if irrelevant) 10 Years 15 Years 20 Years To Age 65 To Age 70 To Age 75 Would you like an additional quote?  Life Insurance  Disability Insurance  Long Term Care Insurance  Health Insurance  Group Health Insurance  Auto Insurance  Homeowners Insurance  Home Loans Click Button Below When Done Please Click Only Once . . . May take up to 30 seconds!   QuikInsurance.com (A Subsidiary of Premier Insurance Brokers) Please Contact Us At Our Toll Free Phone Number: 1-847-241-6544 Privacy Notice/Copyright Info.      © 2002 Insurance-Web-Sales