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CASE DESIGN

"*" indicates required fields

Comments

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:*

Client's Name*

Company Name:** If Not Applicable add N/A

* If Not Applicable add N/A

Client Date of Birth*

MM slash DD slash YYYY

State*

Client's Gender*

Male

Female

Add Spouse

Spouse's Name (If Joint)*

Spouse's Gender*

Male

Female

Spouse's Date of Birth*

MM slash DD slash YYYY

Product Preference

Index Preference (if applicable)

Type of Funds*

Premium Amount ($)*

Total Net Worth? ($)*

Income Deferral Period (Years)*

What is the primary goal and objective?*

Growth

Max Income

Legacy

Single or Joint Payments?*

Single

Joint

Is this an annuity replacement?

Yes

File

Max. file size: 200 MB.

Notes

Life Illustration - Permanent Design Only

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

*For term insurance illustrations, please use the AdvisorHQ link below.

Product Preference:*

Premium or Death Benefit Coverage Amount:*

Smoker/Non-Smoker, Overall Health:*

Notes & Insurance Goals:

Fillable Forms:

DOWNLOAD PDF

DESCARGAR PDF

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

Link for Term Insurance Quote:

AdvisorHQ

How to Run Your Term Quote:

Log in to Advisor HQ
Go to Life Insurance
Click “Quote Engine” to run your term quote
When you’re ready to submit, select “E-Application”

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.

CONNECT WITH QUANTUM

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