FFM - Equity Linked Annuity Offer

Equity-Linked Annuity Request Form

Please complete the following confidential request form to receive your information kit.
Please note: All fields must be completed.

  Name:         
  Address:    
  City:       
  State:           Zip Code: 
  Email:      
  Home Phone:   
  Work Phone: 

  Do you currently own an annuity?            Yes   No
  
  Are you looking to upgrade this annuity?    Yes   No
  
  Are you a mutual fund investor?             Yes   No
    
  Your age is:
     25-35    35-45    45-55    55-65   65-Above
    
  Your tax bracket is:
     27%    30%    35%    38.6%    Unknown
  
  Amount you may want to consider investing: 
     Single    Quarterly    Semi-Annually    Annually

  Potential Source for Funding your Equity Linked Annuity:
     CD       Pension      Cash       Other

  Additional Comments/Questions: