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Name: wf-form-Annuity-Life-Request-Form — GET

<form id="wf-form-Annuity-Life-Request-Form" name="wf-form-Annuity-Life-Request-Form" data-name="Annuity Life Request Form" method="get" data-wf-page-id="65e9deceb32d3b506deb522c" data-wf-element-id="c6d87ab9-6279-aee3-1b55-123db999d57a"
  aria-label="Annuity Life Request Form">
  <div class="form-row"><input class="text-field half w-input" maxlength="256" name="First-Name" data-name="First Name" placeholder="First Name*" type="text" id="First-Name" required=""><input class="text-field half w-input" maxlength="256"
      name="Last-Name" data-name="Last Name" placeholder="Last Name*" type="text" id="Last-Name" required=""></div>
  <div class="form-row"><input class="text-field half w-input" maxlength="256" name="Email" data-name="Email" placeholder="Email*" type="email" id="Email" required=""><input class="text-field half w-input" maxlength="256" name="Phone"
      data-name="Phone" placeholder="Phone*" type="tel" id="Phone" required=""></div>
  <div class="form-row">
    <div class="select-wrap half"><select id="State" name="State" data-name="State" class="select-field w-select">
        <option value="">Select State</option>
        <option value="Alabama">Alabama</option>
        <option value="Alaska">Alaska</option>
        <option value="Arizona">Arizona</option>
        <option value="Arkansas">Arkansas</option>
        <option value="California">California</option>
        <option value="Colorado">Colorado</option>
        <option value="Connecticut">Connecticut</option>
        <option value="Delaware">Delaware</option>
        <option value="Florida">Florida</option>
        <option value="Georgia">Georgia</option>
        <option value="Hawaii">Hawaii</option>
        <option value="Idaho">Idaho</option>
        <option value="Illinois">Illinois</option>
        <option value="Indiana">Indiana</option>
        <option value="Iowa">Iowa</option>
        <option value="Kansas">Kansas</option>
        <option value="Kentucky">Kentucky</option>
        <option value="Louisiana">Louisiana</option>
        <option value="Maine">Maine</option>
        <option value="Maryland">Maryland</option>
        <option value="Massachusetts">Massachusetts</option>
        <option value="Michigan">Michigan</option>
        <option value="Minnesota">Minnesota</option>
        <option value="Mississippi">Mississippi</option>
        <option value="Missouri">Missouri</option>
        <option value="Montana">Montana</option>
        <option value="Nebraska">Nebraska</option>
        <option value="Nevada">Nevada</option>
        <option value="New Hampshire">New Hampshire</option>
        <option value="New Jersey">New Jersey</option>
        <option value="New Mexico">New Mexico</option>
        <option value="New York">New York</option>
        <option value="North Carolina">North Carolina</option>
        <option value="North Dakota">North Dakota</option>
        <option value="Ohio">Ohio</option>
        <option value="Oklahoma">Oklahoma</option>
        <option value="Oregon">Oregon</option>
        <option value="Pennsylvania">Pennsylvania</option>
        <option value="Rhode Island">Rhode Island</option>
        <option value="South Carolina">South Carolina</option>
        <option value="South Dakota">South Dakota</option>
        <option value="Tennessee">Tennessee</option>
        <option value="Texas">Texas</option>
        <option value="Utah">Utah</option>
        <option value="Vermont">Vermont</option>
        <option value="Virginia">Virginia</option>
        <option value="Washington">Washington</option>
        <option value="West Virginia">West Virginia</option>
        <option value="Wisconsin">Wisconsin</option>
        <option value="Wyoming">Wyoming</option>
      </select></div><input class="text-field half w-input" maxlength="256" name="Birthdate" data-name="Birthdate" placeholder="Date of Birth" type="text" id="Birthdate">
  </div>
  <div class="form-row">
    <div class="select-wrap half"><select id="request-type" name="Request-Type" data-name="Request Type" required="" class="select-field w-select">
        <option value="">Request Type*</option>
        <option value="Life Insurance Term Quote">Life Insurance Term Quote</option>
        <option value="Life Insurance Permanent Quote">Life Insurance Permanent Quote</option>
        <option value="Annuity-Quote">Annuity Quote</option>
      </select></div>
    <div class="select-wrap half conditional"><select id="Coverage-Amount" name="Coverage-Amount" data-name="Coverage Amount" class="select-field conditional w-select">
        <option value="">Coverage Amount</option>
        <option value="$500,000">$500,000</option>
        <option value="$1 Million">$1 Million</option>
        <option value="$2 Million">$2 Million</option>
        <option value="$3 Million">$3 Million</option>
        <option value="Over $3 Million">Over $3 Million</option>
      </select></div>
  </div><textarea id="Message-2" name="Message" maxlength="5000" data-name="Message" placeholder="Message" class="textarea w-input"></textarea><input type="submit" data-wait="Please wait..." class="button apply-button w-button" value="Submit">
</form>

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ANNUITY AND LIFE INSURANCE QUOTE

We protect your privacy and do not add you to any lists. You are under no
obligation.

If you would like to call us directly, please dial (843) 884-4545 ext. 25

Securities and Investment Advisory services offered through Cetera Advisor
Networks LLC

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StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew
HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth
DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth
DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Request Type*Life Insurance Term QuoteLife Insurance Permanent QuoteAnnuity
Quote
Coverage Amount$500,000$1 Million$2 Million$3 MillionOver $3 Million

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225 Seven Farms Dr, Suite 106
Charleston, SC, 29492(843) 884-4545info@commonwealthfg.com

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Securities offered through Cetera Advisor Networks LLC (doing insurance business
in CA as CFGAN Insurance Agency LLC, CA Insurance Lic# 0644976), member
FINRA/SIPC. Advisory Services offered through Cetera Investment Advisers LLC, a
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