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44
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1
Name of Agent Taking Call
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2
Thank you for calling RiseUpUSA Life Insurance, my name is..., who do I have the pleasure of speaking with?
Enter Prospect Name Here:
First Name
Last Name
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3
We are here to assist you in building a lasting legacy, for your family, and your church family. If you are ready to get started with some quotes, let's get some basic information.
What is a good email address for you?
example@example.com
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4
Phone Number
Please enter a valid phone number.
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5
What is your street address? Our carrier partners will not accept a P.O. Box.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
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Angola
Anguilla
Antigua and Barbuda
Argentina
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Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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6
Here are some questions we are going to need you to answer in order to find you the best coverage at the lowest price. What Is Your Date of Birth?
Format MM/DD/YYYY
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7
What Is Your Height?
Format (F'I)
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8
What Is Your Weight?
Pounds
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9
Are You A Smoker?
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10
Are You A U.S. Citizen?
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11
What State Were You Born In?
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12
How Much Coverage Would You Like If Able to Be Approved?
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13
When Was Your Last Doctor's Visit?
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14
Was It For A Routine Check Up, Or Something Else?
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15
What Is The Name Of Your Primary Care Physician?
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16
Now we are going to comb through some basic medical questions. Don't worry, we can cover just about everybody, but we do need to know which options are best suited to your individual situation. Do You Have Diabetes?
YES
NO
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17
If Yes, What Type?
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18
Have You Had Stents In The Last Three Years?
YES
NO
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19
Have You Had A Heart Attack In The Last Three Years?
YES
NO
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20
Have You Had A Stroke Within The Last Three Years?
YES
NO
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21
Have You Had Any Type Of Cancer In The Last Three Years?
YES
NO
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22
Have You Had A Ministroke Or TIA In The Last Year?
YES
NO
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23
Do You Have Neuropathy?
YES
NO
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24
Do You Have High Blood Pressure?
YES
NO
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25
Do You Have Lupus?
YES
NO
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26
Do You Have Rheumatoid Arthritis?
YES
NO
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27
Do You Have Thyroid Disease?
YES
NO
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28
Do You Have Asthma Or COPD?
YES
NO
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29
Do You Take Medicines For Anxiety Or Depression?
YES
NO
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30
Do You Have Liver Or Kidney Disease?
YES
NO
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31
Have You Ever Been Diagnosed With HIV/AIDS?
YES
NO
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32
Okay, let's look at some quotes.
Name of Carrier, Coverage Amount, Monthly Premium In The Text Box Below (E.G. Transamerica FEX Express, $10,000, $80.00
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33
How would you like to take care of this today, will it be a checking or savings account? Who Do You Bank With?
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34
What Is Your Routing Number?
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35
What Is Your Account Number?
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36
(Once they agree on a quote - say this:) In the event of your passing, who would you like to designate as your beneficiary, a loved one, your church, or a mix of both?
Beneficiary Selection
Family Member
Church Or Religious Institution
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37
Names, Relationship and Date of Birth For Beneficiaries
Please List with 1,2,3 formatting and percentages for each.
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38
We have to prove to the carrier that you are who you say you are. What is your driver's license number, and expiration date?
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39
What Is Your Social Security Number?
(If they do not want to give this information, let them know the social security number is the way the carrier checks the health of each individual)
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40
Do you have anything that acts like insurance for your retirement, like a Roth Account or 401k?
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41
If Yes, would you like a member of our Advanced Markets Team to speak with you and make sure you are in the best possible situation?
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42
What is the best time of day to speak with one of our team members?
Lock in definite appointment time below.
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43
Our Senior Underwriter is Going to Call You Back Shortly To Verify Your Information. Please have your phone available, and answer their call. So if you see a number you do not recognize, please answer.
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44
Is there anything you would like for me to pray about with you?
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