Contracting Intake Form

Agent Name(Required)

Your Organization(Required)

NPN #(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Fixed Indexed Annuity (FIA) Annual Premium(Required)

$0-500k

$500-2m

$2-5m

$5m+

Target Life Insurance Annual Premium(Required)

$0-50k

$50-100k

$100-250k

$250+

What insurance carriers are you currently using?(Required)

Do you have any questions?(Required)

Kyle Pesch

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James Jacobson

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Kayden Meyersick

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Windy Nash

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Janae Bonner

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Lauren Edwards

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Derek Wakefield

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Stephanie Smith

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Tiffany Nicely

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Contracting Intake Form

CONTACT US

CONNECT WITH QUANTUM

Kyle Pesch

James Jacobson

Kayden Meyersick

Windy Nash

Janae Bonner

Lauren Edwards

Derek Wakefield

Stephanie Smith

Tiffany Nicely

Contracting Intake Form

CONTACT US

CONNECT WITH QUANTUM

Kyle Pesch

James Jacobson

Kayden Meyersick

Windy Nash

Janae Bonner

Lauren Edwards

Derek Wakefield

Stephanie Smith

Tiffany Nicely

Kyle Pesch

VP of Advisor Development

James Jacobson

Director of Strategic Accounts

Kayden Meyersick

Director of Business Development

Windy Nash

Senior Account Manager

Janae Bonner

Director of Advisor Relations

Lauren Edwards

Senior Account Manager

Derek Wakefield

Life Insurance Consultant

Stephanie Smith

Senior Account Manager

Tiffany Nicely

Senior Account Manager