Value Term Life Quote

General Life Rating Factors  Your Current Age    252627282930313233343536373839404142434445464748495051525354555657585960  Gender Male  Female Nicotine Use (and History)    Please SelectNONE - Never Used NicotineNo Nicotine Use for 5+ YEARSNo Nicotine Use for 3+ YEARSNo Nicotine Use for 2+ YEARSNo Nicotine Use for 1+ YEARSNicotine User Recreational Cigar Use    Please SelectNONE - Never Used CigarsRegularly: MORE then 2X a month2X a month 1X a month Occasional 6X per Year (max) Height    Please Select4' 8"4' 9"4' 10"4' 11"5' 0"5' 1"5' 2"5' 4"5' 5"5' 6"5' 7"5' 8"5' 9"5' 10"5' 11"6' 0"6' 1"6' 2"6' 3"6' 4"6' 5"6' 6"6' 7"6' 8"6' 9" Current Weight    90919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302303304305306307308309310311312313314315316317318319320 Any Recreational/Private Avation Activity (Small Private Aircrafts)    Please SelectNoneCurrent have a Private Pilots LicenseVery Rarely, NOT in the past 1+ yearsA Few Times per Year Any Hazardous Sports or Actitives (Professional or Amateur Level) NONE Scuba Diving Sky Diving Rock Climbing Hang Gliding Drag Racing Cholesterol Level    Please SelectUnknown< 250< 270< 280> 280 Curently taking any Cholestrol Medication? Yes  No Cholesterol HDL Levels    Please SelectUnknown< 4.5< 5.5< 6.5> 6.5 Blood Pressure    Please SelectUnknown135/85 or Less140/90 or Less145/90 or Less140/85 or Less150/90 or Less150/90 or MORE Currently taking any Blood Pressure Medication? Yes  No

Motor Vehicle Driving Record - DMV  Tickets (Moving Violations)    Please SelectNONE - CLEAN RECORD12345+  Last 3 years Accidents (Regardless of Fault)    Please SelectNONE - CLEAN RECORD12345+  Last 3 Years Major Violations (DUI's, Reckless Driving, Driving on Suspended License, etc)    Please SelectNONE - CLEAN RECORD12345+  Last 5 Years

Your Personal Health History  Any Personal History of Coronary Artert Disease? Yes  No   Any Personal History of Cancer? Yes  No Any Personal History of Diabities? Yes  No Any Personal Impairments?  Yes  No

Immediate Family History  Your Mother    Please SelectStill Living!!Died over age 65Died at < age 65 due to Coronary Artery DiseaseDied at < age 65 due to CancerDied of other cause Your Father    Please SelectStill Living!!Died over age 65Died at < age 65 due to Coronary Artery DiseaseDied at < age 65 due to CancerDied of other cause Your Sibilings (one or more)    Please SelectAll Still Living!!Died over age 65Died at < age 65 due to Coronary Artery DiseaseDied at < age 65 due to CancerDied of other cause

Select Amount of Coverage  Death Benefit    Please Select$150,000$200,000$250,000$300,000$350,000$400,000$450,000$500,000$600,000$700,000$750,000$800,000$900,000$1,000,000 Waiver of Premium   Yes  No

* = Required Field

 

 

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Based on the Information Input Above
Below is the following Price Indication:
(All final pricing is subject to underwriting approval)


Coverage Amount Selected:   $x,xxx,xxx

Option #1:   10 Year premium:  $xx.xx  per month
Option #2:   20 Year Premium:  $xx.xx  per month
Option #3:   30 Year Premium:  $xx.xx  per month

After the policy is ISSUED:  All 3 options are GUARANTEED Level Premium and Level Coverage for the life of the term
 

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LETS GET THE PROCESS STARTED TODAY: