Chris A Roth

Annuity Needs Assessment

Tell me about your retirement goals so we can see whether fixed or indexed annuity strategies might be a fit for your income and protection needs.

First Name *

Last Name *

Date Of Birth

Phone *

Email *

State

Approximate Retirement Savings (all accounts combined)

When do you plan to start using your retirement money?

Primary Goal with an Annuity

How would you describe your risk comfort level?

Anything else I should know about your situation?

Consent to be contacted *

By checking this box and clicking “Submit My Annuity Assessment”, you agree that Chris A. Roth and/or our partner carriers may contact you at the phone number and email address provided (including by autodialed, prerecorded, or artificial voice calls and text/SMS messages) about annuities, life insurance, and related products. You understand that your consent is not a condition of purchase and that you may revoke consent at any time. Message and data rates may apply. Your information is confidential and will only be used to provide your personalized recommendations.

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