Life Insurance QuoteAssociate.com will take your information and match your policy needs with one reputable insurance agency in your community. Please fill out the application below completely and an insurance agent will contact you within 24 business hours with a fast free and accurate insurance quote. QuoteAssociate.com is not an insurance agency, broker, wholesaler, or underwriter nor do we sell your personal information to any third party.

° Contact Info
First Name:
Last Name:
DOB:
E-Mail:
° Address Info
Street Address:
City:
State:	-- Choose State -- ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
Zip Code:
Home Phone Nbr:
Work Phone Nbr:
When is the best time to reach you?:	-- Choose One -- Anytime Morning at Home Afternoon at Home Night at Home Morning at Work Afternoon at Work Night at Work Weekends
Gender:	MaleFemale
Company/Employer:
Marital Status:	MarriedSingleDivorced
What is your credit like?:	PoorFairGoodExcellent
Social Security Number (Optional)**:
Can one local insurance agent run your credit?:	YesNo
Height:	-- 3 4 5 6 7 8 feet -- 0 1 2 3 4 5 6 7 8 9 10 11 inches
Weight:	Lbs.
° Life Insurance Info
Nicotine Use:	-- Select tobacco use -- Never Current User Within the past year Over 1 year ago Over 2 years ago Over 3 years ago Over 5 years ago
Coverage Amount:	-- Choose Coverage Amount -- 100000 150000 200000 250000 300000 350000 400000 450000 500000 550000 600000 650000 700000 750000 800000 850000 900000 950000 1000000 1050000 1100000 1150000 1200000 1250000 1300000 1350000 1400000 1450000 1500000 1550000 1600000 1650000 1700000 1750000 1800000 1850000 1900000 1950000
Health Class:	-- Choose Health Class -- Best Available Preferred Standard Pref/Tbco Std/Tbco
Term Length:	-- Choose Term Length -- 10 Years 15 Years 20 Years 25 Years 30 Years

What is Life insurance?

Life insurance or life assurance is a contract between the policy owner and the insurer, where the insurer agrees to pay a sum of money upon the occurrence of the policy owner's death. In return, the policy owner (or policy payer) agrees to pay a stipulated amount called a premium at regular intervals.

As with most insurance polices, life assurance is a contract between the insurer and the policy owner (policyholder) whereby a benefit is paid to the designated Beneficiary (or Beneficiaries) if an insured event occurs which is covered by the policy. To be a life policy the insured event must be based upon life (or lives) of the people named in the policy.

Insured events that may be covered include:

• death
• accidental death
• Sickness