We represent many companies and will quote the product with the most competitive company for your individual situation. NOTE THAT YOU MUST COME INTO OUR OFFICE AT 215 W. WASHINGTON ST., MARQUETTE MICHIGAN TO PURCHASE ANY PRODUCT QUOTED!

1. Email address for the return quote and zip code? Enter like yourname@aol.com 49855.

2. Birthdate & Sex? If Husband & Wife (H:01/01/70, W:01/01/70) or Business Partners (P1:Female:01/01/70, P2:Male:01/01/70) list as shown.

3. Do you qualify for a nonsmoker credit? (H:Y, W:N)

4. Is anyone being quoted taking any medication, if so what is it and what is the dosage? (H:Y, W:N)

5. Has anyone being quoted been hospitolized in the last 3 years? If YES, duration and for what. (H:Y, W:N)

6. Type of Life Insurance being requested?

Term - most common
Whole
Universal

7. Amount of Life Insurance being requested? (H:250,000, W:100,000)

8. Any other information that would impact Life Insurance Underwriting?

NOTE THAT THIS INSURANCE CANNOT BE PURCHASED OVER THE INTERNET OR PHONE. YOU MUST COME INTO OUR OFFICE AT 215 W. WASHINGTON ST., MARQUETTE MICHIGAN TO BUY THE QUOTED INSURANCE. THIS QUOTATION IS AN ESTIMATE AND IS NOT LEGALLY BINDING. IT DOES NOT IMPLY ANY COVERAGE HAS BEEN PROVIDED.

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