YES! I Want a Life with LTC Quote for My Client

Thank you for choosing Davis Life & Annuity. Please complete the information below, and we’ll do the rest! You can also make the journey to success even easier by proceeding to our contracting page when you are done.

Your Name(required)

Work Email(required)

Work Phone(required)

Your State(required)

Client's Birthday mm/dd/yy(required)

Client's State(required)

Client's Gender(required)

Client's Height and Weight(required)

Duration (10-30 years)(required)

Coverage Amount (minimum $50,000)(required)

Does the Client Currently have a Life Insurance Policy?(required)

Has the Client ever used tobacco products (Currently use, Quit, or Never Used)?(required)

If the client Quit, how many years ago? (If client never used or is currently using, enter N/A)(required)

Has received any moving violations besides parking tickets in the past 5 years?(required)

Does the client engage in aircraft piloting, bungee jumping, hang gliding, mountain/rock climbing, scuba diving, or sky diving? (If yes, list which activities, If no, enter N/A)(required)

Has the client been treated for alcohol/substance abuse, asthma, blood pressure, cancer, cholesterol, depression/anxiety, diabetes, heart issues, or sleep apnea? (If yes, list which conditions, If no, enter N/A)(required)

Did the client's parents and/or siblings, before they turned 65, have incidents of heart disease, cancer, stroke or diabetes? (If yes, list which family members and conditions)(required)

CLICK HERE to proceed to our contracting page.

Share this: