2005 Advisors' Guide to the Senior Market : Form for Marketing Organizations

2005 Advisors' Guide to the Senior Market Please take your time. This is how your company will be listed in the 2005 Advisors' Guide to the Senior Market. Fields marked * are required. This is the form for marketing organizations, such as wholesalers and brokers/dealers.
*Official Company Name:
*Street Address:
*City:
*State:
*Zip:
*Corporate Telephone:
*Corporate Fax:
*General Company Email:
*Company Web Site:
*Is your company licensed to do business in all 50 states?	Yes No
If no, please indicate the states in which you are licensed:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Please indicate which products your company provides:
Annuities:	Charitable Gift Flexible Premium Deferred Immediate Index Annuities Multi-Year Rate Guaranteed Single Premium Deferred Total Return Fixed Variable
Life Insurance:	Final Expense Global Travel Assistance Impaired Risk Second to Die Single Premium Term Universal Variable Life Variable Survivorship Variable Universal Whole
Long Term Care Insurance:	Individual Non-Tax Qualified Individual Tax Qualified Critical Illness Group
Securities:	Bonds IRAs Mutual Funds Stocks Variable Annuities Variable Life
Other:	Medicare Supplements Life Settlements Viaticals
Which of these services do you offer producers? (Check all that apply):	529 Plan Counseling CE Seminars Legal Consultations Paramedical Services Reverse Mortgage Counseling Sales/Marketing Assistance Software Trust Preparation Underwriting Web Support
Other:	*(Please feel free to include additional products/services, however we cannot guarantee this information will appear in the 2005 Advisors' Guide to the Senior Market.)*
Which of these sales/marketing tools do you offer producers? (Check all that apply):	Collateral Material Copywriting Direct Mail Support E-mail Blast Services Fax Blast Services Leads List Rentals Newsletters Seminar Systems Telemarketing
Other:	*(Please feel free to include additional products/services, however we cannot guarantee this information will appear in the 2005 Advisors' Guide to the Senior Market.)*
What kind of office support do you offer producers?(Check all that apply):	CRM (customer relationship management software) Electronic/CD-ROM Business Cards Errors & Omissions Insurance File Systems Hardware Illustration Systems Promotional Products/Marketing Collateral
Other:	*(Please feel free to include additional products/services, however we cannot guarantee this information will appear in the 2005 Advisors' Guide to the Senior Market.)*
Please identify who completed this form. This information must be completed. We may need to contact you to clarify or confirm the above information.
Contact Name:
Contact Title:
Contact Phone:
Contact Email:
Additional Marketing Opportunities:
Would you like to be contacted about placing your company's logo next to your listings in the 2005 Advisors' Guide to the Senior Market?
	Yes No
Would you like to be contacted about advertising in the 2005 Advisors' Guide to the Senior Market?
	Yes No
To talk to someone immediately about logo and advertising opportunities, please call Amy Guettler at (303) 662-5336.