Testimonials

"You guys have cut my health insurance premium to half. I couldn't have asked for a better deal!"
- Jenny Smith, CA.

"You just saved me 30% on my auto insurance. Thank you!"
- Paul Johnson, CA.

Group Life Insurance Quote

   

General Information

Business Name: *
Premises Address:
City:
State:
Zip:
Email: *
Contact Name: *
Phone:
Fax:
Years in Business:
Federal Employer's ID #:
Description of Operations or SIC code:
Current Insurance Company:
Policy Expiration Date:

Illinois Group Term Life Insurance Coverage Information:

Group Term Life Insurance Objective:
Amount of Life Insurance Per Employee:
Other Amount:
$

Illinois Employee Information:

How many employees to be insured:
Did any employee to be insured have health problems during the past 18 months?
If "Yes", please list information below.:
Does any employee to be insured have a hazardous job?:
Yes  No
If Yes, how many have hazardous jobs?
Employees to be insured active members of the military reserves?
Yes  No
If Yes, how many are active members of the military reserves?

Additional Information:

Comments: