Needs Assessment

What kind of services would you need for your next trip (Select all that may apply)

Where do you plan to travel next?

Indicate all destinations if our trip includes multiple destinations

How many adults?

Age 18 and over

How many children age 2-18

Will your travel include: (select all that apply)

When would you like to be covered by life insurance?

What’s your gender?

What’s your birth month and year?

01/1950 for January 1950

How is your health?

Do you currently use nicotine products?

How many children do you have under 18?

Do you have an Estate Plan or Will in place?

Would you be interested in policies that include an option to create a will or trust fast, simple, and free?

Your personalized coverage needs will help cover your financial obligations and give you peace of mind. In the event of an untimely death your loved ones will get a lump-sump payout tax-free that can help:

Replace your income, experts recommend getting coverage worth 6-10 times your annual income.
Children's tuition cost, the cost of higer education can range from $50,000 - $100,000+ per child.
Retirement planning, the average retirement income for retirees 65+ is $47.357. Average mean retirment income is $73,228.
Funeral Expenses, funeral costs in the US range from $7,000 - $15,000+

Are you a US citizen or permanent resident?

Whom do I have the pleasure of speaking with?

First NameLast Name

What's a good Phone Number to deliver your personalized quote

Cell phone preferably if you would like to receive textFormat: (000) 000-0000.

What's a good Email address to deliver your personalized quote?

example@example.com

By clicking "Submit", I confirm that I have received, read, and agree to the

Phone and Text Consent. accessible by clicking on the hyperlink.

I am a licesensed and appointed insurance producer representing multple A-rated insurerance companies that gives me the flexibility to shop around for the best deal for every need situation or budget saving you time and money in the process.

I do receive compensation from the insurance companies through the sale of the insurance products that I offer and service if you were to purchase a policy using my service.

National producer number 19280181 Licensed in CA, CO, DC, FL, GA, HI, MD, MI, NM, OH, OR, PA, SC, TX, UT, VA, WA. Lines of Authority Life, Health, Accident and Sickness, Disability, Long Term Care and Annuities.

CA Residents Only

NOTICE OF TAX CONSEQUENCES AND PENALTIES FOR SENIOR CONSUMERS

California Insurance Law, Ins s 789.8, requires that every life insurance agent, who offers to sell a life insurance policy or annuity contract to a senior consumer (age 65 or greater) must provide the following written notice.
• The sale or liquidation of any stock, bond, IRA, certificate of deposit, mutual fund, annuity, or other asset to fund the purchase of this life insurance policy or annuity contract, may result in one of the following;
a) tax consequences
b) early withdrawal penalties
c) or other costs or penalties
• You may wish to consult independent legal or financial advice before selling or liquidating any assets and prior to the purchase of any life insurance or annuity product.