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Rollover Request 

Existing Policy: Rollover Request

Contact Information:
Your Full Name:
(as listed on policy now)
Policy/Contract Number:
Name of Insured on Existing Policy:
Policy Owner:
Name of Annuitant:
(if different)
Current Financial Institution:
Your Email Address:
Daytime Telephone Number:
Transfer Rollover FROM:
ROTH IRA S.I.M.P.L.E. IRA
SEP IRA 401 (k)
Other
If Other, Please Specify:
Transfer Rollover TO:
ROTH IRA
SEP IRA
S.I.M.P.L.E. IRA
401 (k)
Other
If Other, Please Specify:
Comments or Questions:

By submitting this form you understand that no coverage is bound until you receive written notice. Changes to policies via this website are not effective or binding until you, or any party involved, receive official notification from your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Enter the security code you see above. Code is NOT case sensitive. *
Exceptional savings for "average" people.

“I use Winooski Insurance personally and also refer them to my clients. Their rates are very competitive and their staff is friendly and effi cient.”

Mark Chaffee
Mortgage Financial, Inc.

“When I switched my home and auto coverage to Winooski Insurance, they didn’t just try to sell me the same policy. They asked me the right questions to get me better coverage, while saving me money. I feel confi dent that they shop the best price for me each year.”

Sue Gosselin
Colchester, VT.


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