Request an Individual Quote - If you are looking for a customized quote, please email details to sales@bcgtermfund.com

(* = Required)
First Name: *
Last Name: *
Address: *
Company:
City: * State: *
Zip: *
Telephone: *
Fax: Email: *
 
 
Employer/Plan Name:
 
Annuitant Name:
Sex:      Date of Birth: 
Co-Annuitant Name:
Sex:      Date of Birth: 
 
Purchase Date: Commencement Date: 
Type of Funds: Qualified Non-Qualified
Type of Plan: Defined Benefit    Defined Contribution
 
Name of Purchaser:
(ie, Plan Trustee etc.)  
Monthly Benefit Premium Amount:
State:
Option Requested:
Life
 Life with 5 years Life with 10 years
Life with Cash Refund Life with 15 Years Life with 20 Years
J&S 50%  J&S 66 2/3% J&S 75%
J&S 100%
 
Period Certain: (Months, ie 60, 120 etc)
COLA % Annually
 
Benefit Reduces on Death of Participant Only
Benefit Reduces on First Death
 
Is the agent/requester insurance licensed? Yes No
If yes, are commissions to be included? Yes No
 
Questions or Comments:
 
How did you hear about us:
Website
Mailing
 Conference
Referral Newsletter Existing Client
 
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