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Information required for review:

Index Annuity:

• Name: ___________________________________
• How Do We Contact YOU: ___________________
• Best Time for Interview:___
• Planning Direction:  Growth __  Income __

Long Term Care and/or Insurance:

• Full Name
• Age at last birthday
• Sex
• Height____ and Weight____
• Tobacco user or NonTobacco user
• Resident City and State
• Living Independily  or Assisted Care Living
• Contact information and best time to contact you!

Ananias Washington: awe@aweinsurance.com  

P O Box 26645 Overland Park, Kansas 66225-2645

913-484-4018

Quick  And -- Confidential Service