NextPoint proposals are detailed. Please allow 3 to 5 business days.

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* 1. Please enter your contact information

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* 2. Through what IMO or brokerage firm will you likely place this case?

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* 3. Please rate your existing relationship with this client

1 Relationship Scale 10
i We adjusted the number you entered based on the slider’s scale.

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* 4. What program(s) are you interested in presenting?

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* 5. Actual Name of Client (if known)

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* 6. Gender (Primary Insured)

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* 7. DOB or Age (Primary Insured)

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* 9. Gender (Secondary Insured, if any)

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* 10. DOB or Age (Secondary Insured, if any)

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* 12. Policy Design (check all that apply)

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* 13. Solve amount (annual premium or annual interest or death benefit or amount of income beginning at a certain age)

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* 14. Qualified Plan Account Balances (if any)

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* 15. Household Net Worth

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* 16. Household Income

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* 17. State

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* 18. Other Residences

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* 19. Other Relevant Case Information

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* 20. For a fully detailed financial analysis, complete and upload the Personal Financial Questionnaire.

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* 21. I understand that POP, ROP and EOP are copyrighted programs belonging exclusively to NextPoint Solutions, and I agree to respect all intellectual property rights, trade secrets, and other rights related to the program as they may be defined and amended from time to time.

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* 22. I understand that any information I receive from NextPoint Solutions, to the extent that it is not already in the public domain, is Confidential Information and I shall treat it as such. Accordingly, I agree to use such Confidential Information only to do business with NextPoint in accordance with NextPoint's normal rules and procedures, and not to do business on my own, or to share such Confidential Information with competitors of NextPoint.

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* 23. The Parties agree that the Confidential Information is disclosed “As-Is.”  Nothing contained in this Agreement or in any confidential information shall constitute any express or implied warranty of any kind, including without limitation, any warranty or merchantability, fitness for a particular purpose, or non-infringement.

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* 24. I further understand that neither NextPoint Solutions, nor any of its principals or employees, practices law, and accordingly does not offer legal advice. Upon request, NextPoint may recommend experienced counsel. Clients are encouraged, nonetheless, to seek their own legal counsel, as well as professional tax advice.

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* 25. In consideration for everything described above, I understand that, if I am successful in my efforts to sell this case, I will share my commissions with a designated appointee of NextPoint by placing the name and agent code of said appointee(s) on the application for the agreed upon percentage entered below. My input of anything greater than 0% indicates my agreement. (The default split is 35%. Use this if you are unsure.)

0% 50% 100%
i We adjusted the number you entered based on the slider’s scale.

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* 26. I acknowledge and appreciate that NextPoint Solutions may be running proposals, making presentations and otherwise providing support services in cases that may, for any number of reasons, not lead to the sale of POP, ROP or EOP specifically, but may instead lead to the sale of some other similar insurance product or strategy. Nonetheless, if meaningful work has begun, such that proposals have been created and/or discussions have taken place, this Agreement shall nonetheless apply.

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* 27. Print your name to act as your signature and accept the above Agreement

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