THE WORRYFREE RETIREMENT® NETWORK

MEMBER APPLICATION

* Asterisk Indicates Required Field

Date

MonthDayYear

Agency Name

Dressander|BHC (DBHC) Marketing Consultant Name

First Name

Last Name

Street Address

City

State

Zip Code

Mobile Phone

Business Phone

Business eMail

Current FMO

FIA Annuity Premiums Current Year

Enter Dollar Amount

FIA Annuity Premiums Previous Year

Enter Dollar Amount

Primary Carriers with whom the above FIA production was placed

Approx Dollars Spent on Marketing Current Year

Enter Dollar Amount

Approx Dollars Spent on Marketing Previous Year

Enter Dollar Amount

1. Will you commit to a one-time set-up fee of $450 and a recurring monthly subscription fee of $199 for access to website and income planning software/database?

2. Will you commit both financially and mentally to the success of the program by producing a minimum of $2 million in annual indexed annuity production in the next 12 months?

3. Will you commit to placing all of your indexed annuity business solely with DBHC?

4. Assuming you do not already have your American Equity contract with DBHC, will you commit to immediately moving it to DBHC?

5. Will you commit to immediately moving at least two of the core carriers listed to DBHC: National Western, Allianz, F&G, Nationwide, Forethought and/or Annexus?

6. If not already an RIA (registered investment advisor), will you commit to obtaining your RIA (series 65 license) within one year after joining the Network?

7. Will you agree that you currently have $25,000 of capital/savings (for marketing and branding efforts) OR can confirm that you already have a fairly large group of prospects you can contact about the WorryFree Retirement?

8. Will you commit 100% of your time and energy to the 6-session coaching calls with Tony and complete all homework prior to each session?

9. If you desire to be released from the Network, will you agree to return all materials to DBHC and WorryFree, Inc.?

Signature

I understand I will be asked to complete a Kolbe A™ Index assessment as part of the WorryFree Retirement^® Network application process and will be personally responsible for the associated cost. Applicant will forward results of Kolbe A™ Index to both DBHC and WorryFree, Inc. Completion of the assessment does not guarantee acceptance into membership.

A Marketing Consultant from Dressander|BHC will contact you to discuss next steps in detail.