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Life Insurance Lead Sample

Life insurance leads have been a part of our offering to agents since our companies inception. The life quote form is a relatively straightforward form that includes more data than many other 'life leads'. All contact information is required and most other information is completed at the time of the quote request. We do ask the consumer to gauge their own level of health and include areas to describe any health concerns, conditions and/or medications.

We are always open to feedback regarding our life lead forms and welcome suggestions from our agent network.

Life insurance quote sample.

This quote was submitted on: 09/30/2003

CUSTOMER INFORMATION:
Name: ****
Address: ****
City, State Zip: pass christian, ms 39571
Home Phone: (228) ****
Work Phone: ****
Alternate Phone:
EMail: ****

Date of Birth: XX/XX//1949
Gender: Female
Height: 64
Weight: 159
Tobacco User: Yes
Occupation: accountant
Health: Excellent
Any Specific Health/Medical Problems:

COVERAGE INFORMATION:
Coverage Amount: 200,000
Type of coverage desired: Term

ADDITIONAL COMMENTS: N/A

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