

Contact Information
Name
Address
City
State
Zip
Phone
Email

Policy Information
Date of Birth
How much monthly income would you like your annuity to provide?
Would you like to get money immediately from an annuity, or would you prefer to wait several years?
Immediately Wait a few years
Would you like your annuity to generate a fixed income, or are you comfortable with variable returns?
Variable returns Fixed income
Do you have a large sum of money to commit to an annuity, or would you consider making contributions over time?
Lump sum Over time
Any additional information to consider as we process your request?

Securities and Advisory Services offered through Hornor, Townsend & Kent, INC. (HTK), Member FINRA/SIPC, Registered Investment Advisor 1475 S. State College Blvd., Suite 114, Anaheim, CA 92806