Life Insurance Made Easy
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Do you currently have life insurance?
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Select
Yes
No
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What is the face amount of your policy?
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Select Amount
Less than $100,000
$100,000 - $199,999
$200,000 - $299,999
$300,000 - $399,999
$400,000 - $499,999
More Than $500,000
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What type of policy do you have?
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Select Policies
Joint Survivorship or Whole Life
Term Life
Universal Life
Joint Survivorship With One Deceased
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Would you like a free appraisal of the current value of your policy?
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What is your gender?
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Choose
Male
Female
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What is your marital status?
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Married
Single
Divorced
Separated
Widowed
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Do you have children?
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What is your job status?
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Select Status
Currently Employed
Retired
On Disability
Homemaker / Other
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Have you used tobacco products within the last 12 months?
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Yes
No
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In the past 5 years have you been treated or prescribed medication for any of the following conditions?
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I Have No Medical Conditions
Anxiety, Depression, or Bipolar
Chronic Pain
Heart or Circulatory Disorder
Cancer
Diabetes
Respiratory Disorder
Other Medical Condition
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Do you have a mortgage?
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Do you have any other debt?
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Yes
No
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Are you looking for the policy to cover your final expense?
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Yes
No
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What type of funeral are you looking for?
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Select type
Casket
Cremation
Not sure
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How much coverage looking for?
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Select Coverage
$3,000
$10,000 $10,000
$15,000 - $25,000
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Are you looking for temporary or permanent?
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Temporary
Permanent
Neither
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How much temporary/permanent are you looking for?
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Select Amount
Less than $100,000
$100,000 - $199,999
$200,000 - $299,999
$300,000 - $399,999
$400,000 - $499,999
More Than $500,000
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Who will be your beneficiary?
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Date of birth
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What is your height?
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What is your weight?
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City
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State
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Last step! Your quote is ready.
First Name
Last Name
Email
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Phone
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