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Fixed Annuity Quote Request
To receive a free universal life insurance quote from the Perrine Agency, answer the following questions and submit.  An agent will analyze your information and contact you shortly.  You may also print out this page, fill in at your convenience, and fax to us at (952) 888-1134.

 YOUR INFORMATION
 
  First Name
 
  Middle Name
 
  Last Name
 
  Street Address
 
  City
 
  State
  
  Zip Code
 
  Phone (Work) - include area code and extension
  Phone (Home) - include area code
  Email Address
  Date of Birth (month/ day/ year)
Gender:    Male    Female
Yes    No  -   Do You Currently Have An Annuity Investment established?

 If yes, kind do you have?  (eg fixed, immediate, variable, index, not sure)
Yes    No  -   Are You, Your Dependents, or Spouse Pregnant?
What is your annual salary?  $ 

What is the best time of day to reach you by phone? 

Enter any comments/ questions/ suggestions below:

Click below to submit information.

 

 

 

 

 
 


"Don was able to find us the best package to meet our needs at the best price and provided friendly, personal service.  Glad we found you!"

Kevin & Jill Unterreiner
Eden Prairie, MN