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NEW BUSINESS

SUBMISSION FORM

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Client Name*
First Last
Carrier
Product Type
- Fixed Indexed Annuity
- MYGA
- IUL
- Term
- Other
Product Name
Policy #
Writing Advisor
Split Code
Untitled
- Life
- Annuity
Untitled
- Lump Sum
- Multiple Payments
Frequency
- Annual
- Quarterly
- Monthly

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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