Posted on May 10th, 2008
Written by admin
Your Name (required)
Birthdate/Age (required)
Contact Info - Phone and/or email (required)
State of Residence
Type of Insurance Needed (required) Life Health Disability Long Term Care
Please fill in the areas below that relates to Type of Insurance that is needed based on selection above.
Life Insurance Quotes:
Tobacco Use Y/N (required) Yes No
If Yes above, type and frequency
Type of coverage: Permanent or term? (required) Permanent Term
If permanent above, whole or variable Whole Variable
Health Summary (required) Excellent Standard Sub-Standard Rated
Definitions Excellent=excellent health and health history; Standard=good health and health history; Sub-standard = adverse health or risky lifestyle such as piloting, motor-racing, sky-diving, etc...; rated=specific major health issues
Health Insurance Quotes
Zipcode (required)
Desired Deductible Range (required) $500-$1000 $1000-$2500 $2500-$5000 $5000+
Disability Insurance
Occupation (required)
Annual Salary (required)
Amount of Coverage based on what % of salary (required) <25% of income 25-50% of income 50-75% of income
Long Term Care Insurance
Policy Desired (required) Individual Joint
Exclusionary Period (required) 30 days 60 days 90 days
Length of coverage (required) 2 years 3 years 4 years 5 years > 5 years
Monthly Benefit Amount Desired? (required)
