Request a Quote

Request Life, DI, Group Health, & LTCI Quotes

Send a Quote Engine to Your Clients

This is a great tool (left) for generating Life Business. It takes the mystery of Life Insurance out of the process, lets them feel in control, educates them on Risk Class, and gives them what they want all at the same time. The best part is it shows them you are shopping for them so they don’t need to!

I want This Rater For My Website or Email

Use the Quote Request Forms

Below are both electronic and downloadable PDF forms (some of us still like faxes and/or writing things down). For easy access and convenience use our E-Quote System and receive an immediate response!

Printable Life Quote Request Form
Printable Group Health Quote Form
Printable Disability Quote Form
Printable Long Term Care Quote Form

Life Support Fast App Program

Not sure exactly what your client wants or needs, don’t have the time to hassle with Life Insurance, but want to add it to your business… Looking for a Life Insurance Professional (us) to guide them through the different options and what may be best for them. Fill out the 1 Page Fast App, make sure to get a best time for them to be reached – We do the rest. You get a check! Who’s better than us!

Go To Life Support – Fast App

Request Forms

Download the form below, or fill out form online!

Life Quote Request Form

Life Quote Form

Choose the type (or types) of policy your client is interested in:
Download the form below, or fill out form online!

Group Health Request Form

Group Health Quote Request Form

Upload
Number of Employees Currently Enrolled in Benefits
Please note: Groups located outside NY must complete additional Employee Census 
Download the form below, or fill out form online!

Long Term Disability Quote Request Form

Long Term Disability Quote Request Form

(Gross Adjusted Income = Income – Expenses before Tax)
If Business Owner
Download the form below, or fill out form online!

Long Term Care Quote Request Form

Long Term Care Quote Request Form