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CASE DESIGN

Name
This field is for validation purposes and should be left unchanged.
Are you filling out an annuity or life illustration?*
- Annuity
- Life Illustration
Annuity
VP of Advisor Development*
Agent's Name (First & Last Name):*
Agent's Email:*
Company Name:** If Not Applicable add N/A
* If Not Applicable add N/A
Client's Name*
Client Date of Birth*
MM slash DD slash YYYY
Client's Gender*
- Male
- Female
Add Spouse
- Add Spouse
Spouse's Name (If Joint)*
Spouse's Date of Birth*
MM slash DD slash YYYY
Spouse's Gender*
- Male
- Female
State*
Product Preference
Index Preference (if applicable)
Premium Amount ($)*
Type of Funds*
Total Net Worth? ($)*
What is the primary goal and objective?*
- Growth
- Max Income
- Legacy
Single or Joint Payments?*
- Single
- Joint
Income Deferral Period (Years)*
Is this an annuity replacement?
- Yes
- No
File
Max. file size: 200 MB.
Notes
Life Illustration
VP of Advisor Development*
Agent's Name:*
Agent's Email:*
Meeting Scheduled for:
MM slash DD slash YYYY
Client's Name (First & Last Name):*
State*
Male/Female/Joint
- Male
- Female
- Joint
Date of Birth / Age(s):*
Total Net Worth? ($)*
What is the primary goal and objective?*
- Accumulation
- Protection
- Term Policy
Product Preference:*
Premium or Death Benefit Coverage Amount:*
Smoker/Non-Smoker, Overall Health:*
Notes & Insurance Goals:

Fillable Forms:

Si prefiere completar el formulario de solicitud de diseño de caso en español, por favor descargue el PDF editable, rellénelo y envíelo por correo electrónico a casedesign@thequantum.com

CONTACT US

Toll Free: 800.440.1088
Voice: 480.949.1088
Fax: 480.949.2427

18700 N. Hayden Rd., Suite 310

Scottsdale, AZ 85255

The Quantum Group® provides marketing, distribution, training, and support services for annuity and insurance products offered through licensed insurance carriers to financial professionals.

The Quantum Group, USA, LLC, an Arizona limited liability company. In CA, d/b/a Quantum Distribution & Insurance Services LLC. License # 0M85682. The Quantum Group, USA, LLC. is licensed in all states except Alaska and New York.

For producer use only.

© 2025 The Quantum Group, USA, LLC.

CONNECT WITH QUANTUM

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Home
Our Story
- Ron Shurts
Meet the Team
Our Services
Blog
- FAQs
Careers
Contact
Advisor Login

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