Immediate Income Annuity Payout Options:
{Please Select the Options You Want Quoted}
Single Life Options: Payments on your Life and Guaranteed for as long as you live. Payment Ends at your death for Life Only. Life with X Years Certain adds a guarantee to payments and the remaining payments will be paid to named beneficiaries should you die shortly after purchase. Life with Installment Refund pays for as long as you live and if you die prior to recovering your initial investment: payments will continue to your beneficiaries as scheduled until this recovery occurs.
	Life Only Life with 5 Years Certain Life with 10 Years Certain Life with 15 Years Certain Life with 20 Years Certain Life with Installment Refund
Joint and Survivor Life Options: Payments are Guaranteed for as long as you and your spouse live. Payments end at Second Death. Guarantees are similar to the single Life options described above. You may also choose an option with a reduction in payments at the first death.
	Joint & Survivor Life Joint & Survivor Life with 5 Years Certain Joint & Survivor Life with 10 Years Certain Joint & Survivor Life with 15 Years Certain Joint & Survivor Life with 20 Years Certain Joint & Survivor Life with Installment Refund Joint & 75% Survivor Life (At the first death payment reduces for the survivor.) Joint & 66.67% Survivor Life Joint & 50% Survivor Life
Options NOT based on Life: Payments Guaranteed for a Certain Period of Time. Zero remains at end of this period. If needed ask and we can quote any year between 5 and 40 years.
	5 Year Period Certain 10 Year Period Certain 13 Year Period Certain 15 Year Period Certain 18 Year Period Certain 20 Year Period Certain 25 Year Period Certain 30 Year Period Certain
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Now that you selected a Payout option: You need to tells us the key's to determining what amount these payouts will be:
Enter Either: The Amount / Lump-Sum you will Deposit - Up to $2.50 Million (Higher Amounts must Call) and Monthly Payments Starting in 30 Days will be Quoted.
OR:
The Monthly Income you want to Receive and the Amount/Lump-Sum Required to obtain this Income will be Quoted. Then Enter -0- in Lump-Sum.
Enter Amount / Lump-Sum: $
OR:
Enter Monthly Income you want to Receive: $
PLUS the
Total Value of Your Entire Portfolio: $	*
Please Select the ONE that best describes the Primary Source of Funds for this Income Annuity:
Non-Qualified:	(Please Select)InheritanceSale of 2nd 3rd or other HomeSale of Other Real EstateSale of BusinessInvestment Account (Bonds and/or Stocks)Money MarketSavings AccountChecking accountMaturing CD'sMaturing Deferred AnnuityVariable AnnuityLife Insurance Cash Value (1035 Exchange)Lawsuit Settlement
OR:
Qualified (Pre Tax Funds):	(Please Select)IRA and IRA Rollovers (Retirement Account)401K (Pension Account)Profit Sharing Plan403b (TSA Account)457 Plan (Pension Account)SEP or Keoh (Pension account)Defined Benefit Plan Termination or Lump-Sum Settlement (From Pension)
Annuitant Personal Information:
Name (Skip if same as contact person):
Gender:	(Please Select)MALEFEMALE
Date of Birth: (mm/dd/year):	*
State of Residence:	*
Spouse Information:
Spouse Name:
Spouse Gender	(Please Select)MALEFEMALE
Spouse Date of Birth (mm/dd/year):
*Other Details:
Please Explain your Objectives in more Detail and Provide any other information you think I should know in order to show you the very best and most accurate Immediate Income Annuity Quotes on the market:
Objectives and More Detail:
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Contact Information:
First Name:	*
Middle Initial:
Last Name:	*
Email Address:	*
Re-Enter Email Address:	*
DayTime Phone#:	*
Home Phone #:	*
Fax #:
Address:	*
City:	*
State:	*
Zip Code:	*
* When Do You Intend to Buy this Immediate Annuity?
Please give your very best estimate as we will quote your age at the expected time of your purchase.
	Right Now (Within Day's) Immediately (Within 3 Weeks) Immediately (Within 5 weeks) Within 2 to 3 Months Within 4 to 6 Months Within 7 Months to 1 Year Longer than 1 Year
Important Information:
Where Do You INTEND to BUY this Immediate Income Annuity?
	Move from Here to Select the TRUE Choice...OR...We Will NOT Respond!!! I prefer to Buy Directly (Over Phone & FedEX) without Meeting with an Agent or Broker or Advisor. I intend to buy through an Agent or Broker or Advisor I already know. I want to meet with an Agent or Broker or Advisor from JDSAnnuities.com. I am the Agent or Broker or Advisor. I am a Trustee or CPA or Attorney. I am already a Client of Joseph D. Salvemini - JDSAnnuities.com / JDS FS.
All information is required in order to provide you with accurate quotes/information and detailed brochures.
All information you provide will be kept confidential.

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