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Term Life Quote Request

Term life insurance provides the most death benefit protection for the least amount of premium for a limited period of time. However, term life insurance is not considered to be Permanent insurance. Other forms of life insurance should be considered if you wish to build cash value, take tax-free loans or create a permanent protection against premature death. Term life insurance is commonly used to create a pool of dollars to pay for debts like a  mortgage, college funding and  for general survivorship benefits upon the death of the insured. Term life insurance is commonly available for one, five, ten, fifteen, twenty, twenty five and thirty year periods. Time frames maybe limited depending on age. Term life insurance is medically underwritten by the insurance company, assuming the risk. A partial list of  variables considered by the insurance companies include: gender, age, height, weight, smoker/non-smoker, blood pressure readings, total cholesterol reading, ratio of HDL to total cholesterol, medications taken, hobbies, occupation, illnesses and history of illness or death of parents or siblings prior to age 60. Life insurance companies take on tremendous risk when they underwrite a life insurance policy. Their underwriting procedures help control the risk of  writing life insurance policies. 
   

Term life insurance premiums vary greatly between  insurance companies. We subscribe to an electronic quoting system that quickly provides term life quotes based on the information provided. Quotes provided are not guaranteed until the insurance company underwrites the life insurance application and issues the policy. Material misstatements on a life insurance application are considered a third degree felony in the State of Florida.  The more accurate the information provided the more reliable the quote provided. Please complete the life insurance quote form below to receive a confidential free no obligation quote. 

 

*Required Fields

 

First Name*    Last Name*
Address*
City* State* Zip*  

E-Mail
Home Phone* () - 

Work Phone  () - x
Cell Phone () -
Preferred Method of  Contact: Home Phone Work Phone Cell Phone E-Mail
Best Time To Contact You Monday - Friday: 9AM-12PM  12PM-1PM   1PM-5PM

Other
Male Female     Have  You Smoked In The Last 36 Months?* Yes   No

Date of Birth* / Married  Single 
Height* ' "  Weight*

If known Please Provide the following information
Total Cholesterol ex: 190 HDL/Total Cholesterol Ratio ex: 5.0
Recent Blood Pressure Reading ex: 120/80

How is your health?*

Excellent  Good Average  Poor

List any health conditions. eg: asthma, diabetes, 

heart disease, etc.


List any prescription medication you take.

How much life insurance do you want?*

$100,000  $200,000   $300,000  $400,000 $500,000 $1million   
Other

How long do you want your rates guaranteed for?*

10 Years  15 Years   20 Years  30 Years

Other

Convertible to Permanent Insurance - Yes No

Waiver of Premium - Yes No