The ABS Affiliate Agent Practice Qualification Form
Name:
Business Name:
Street Address
City:
Zip:
State:
Business Phone:
Fax:
Email:
States you currently market in:
Number of existing clients:
Method of prospecting or increasing clientele:
Errors & Omission Insurance:
Yes
No
MARKETING PRODUCT MIX:
ANNUITIES:
FIAs -
%
Traditional Fixed -
%
MYGAs -
%
SPIA -
%
SECURITIES:
Variable Annuities -
%
Mutual Funds -
%
Other -
%
LIFE INSURANCE:
Term -
%
Permanent -
%
Services you provide to clients:
How did you hear about "The ABS Affiliate Agent Practice"?
Advertisement
Email from ABS
Phone Solicitation from ABS
Referral
COMPANIES YOU CURRENTLY DO BUSINESS WITH:
ANNUITES
1.
Production for 07
08
09
2.
Production for 07
08
09
3.
Production for 07
08
09
4.
Production for 07
08
09
5.
Production for 07
08
09
Briefly explain how you promote your services today?
COMPANIES YOU CURRENTLY DO BUSINESS WITH:
LIFE INSURANCE
1.
Production for 07
08
09
2.
Production for 07
08
09
3.
Production for 07
08
09
4.
Production for 07
08
09
5.
Production for 07
08
09
PREVIOUS YEAR'S PRODUCTION:
(PLEASE PROVIDE DOCUMENTATION
Annuity:
Life:
Other:
PRODUCTION COMMITMENT YOU WILL MAKE TO ABS:
Annuity:
Life:
Other:
There is a $20/month technology fee for agent participation in the Agent CRM and Client /Agent system. By checking this box you are signifying your acceptance of this fee. Once you application has been approved you will be contacted for your payment information.
