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We write a variety of Washington programs for homeowners and can issue your homeowners policies SAME DAY to help with your home loan closing or refinance. Look at these features:

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  • On-Line Life Insurance
    Quotation Form
    One Simple Form - takes only 2-3 Minutes!


    Your Personal Data:
     
    Your Name:
    Street Address:
    City:
    State: (Must be Washington)
    Zip Code:
    E-Mail (REQUIRED):
    E-Mail again for accuracy:
    Phone:
    Fax (optional):
    Primary Insured's Occupation:
     
    Are You Married?
    Yes No
    Currently Insured?
    Yes No
     
    If currently covered list carrier, # of years covered, and type of coverage
     
    Unusual Activities?
    (If you engage in unusual activities such as scuba diving, airplane flying, rock climbing, etc., list them here.)


    Underwriting Information:
     
    Name of Proposed Insured:
    Enter Proposed Insured's Birthdate:  
    Sex (M/F): Do You Smoke?:
    Height: Weight:
    Spouse's Information:
    (Leave Blank if you do NOT want Spouse Coverage)
     
    Name of Spouse:
    Enter Spouse's Birthdate:  
    Sex (M/F): Do You Smoke?:
    Spouse Height: Spouse Weight:



    Coverages:

    Amount of Coverage Desired?
     
    Type of Life Coverage Desired?
     
    TERM = Pays death benefit only - This is lowest cost for coverage.
    UNIVERSAL LIFE = Has savings aspect in addition to providing death benefit.
    OTHER = Would be mortgage protection, whole life, no-exam life, etc.
     
    Years of Level Premium, if selecting term life.
     
    List Any Health Problems:
     
    Reason for Buying Life Insurance:
     
    Send my quotation via: E-Mail Fax
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    Thank you for filling out this form COMPLETELY!

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