For your free "quik quotes" of the industry's lowest cost Term Insurance Plans simply complete the following form and submit it to us or call us at 
1-800-990-TERM (8376).

Quotes by: Phone     Fax     Mail

E-mail:

Name:
Street Address:
City: State:

Zip:
Home Phone: * Please Include Area Code
Work Phone: * Please Include Area Code
Fax Number: * Please Include Area Code
Birthday:

Sex:

Male  Female

Smoking Status:

Smoker  Non-Smoker (No tobacco in any form for 5 years.)

Coverage Amount:

$
Most financial experts recommend 5 to 10 times your annual income.

Type Of Plan:

* Yearly Renewable Term (Rates Increase Annually)
Level Premium Term
* Fixed Rate For 5, 10, 15, 20, 25 or 30 Years

Additional savings may be possible when a spouse is covered as well.

Spouse's Name:

Birthday:

  Year

Smoking Status:

  Smoker    Non-Smoker (No tobacco in any form for 5 years.)

Coverage Amount:

$

 Most financial experts recommend 5 to 10 times your annual income.

Type Of Plan:

Yearly Renewable Term (*Rates Increase Annually)
Level Premium Term
Fixed Rate For 5, 10, 15, 20, 25 or 30 Years

All information will be kept strictly confidential. 

*Rate guarantees
will vary from company to company.

                                                              

Copyright 2000 Professor Quotewise
A Division of Andrew R. Johns &
Associates, Ltd.
Last modified: May 05, 2000
E-mail comments: pqwise@pqwise.com 
Fax us at: (815) 777-8473
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