Agent Marketing Information Request

      To receive Information, you must be a currently licensed Insurance Agent in your resident State.

                 Web Based Insurance Products

             Individual Major Medical    Individual Dental Plan

             Guarantee Issue Medical, with Dental and Vision benefits.

             Simplified issue Level Term Life up to $250,000

             Simplified Issue Whole Life to Age 85

                 Traditional Insurance Products                 

             Simplified issue Term Life with traditional paper application process

              Simplified issue Whole Life with three in one Application from preferred to Graded Benefit.

             Indexed Universal Life  (High Commission  contract up to 105% of Target)  

             Annuity Portfolio (indexed, indexed & Fixed account combo, Fixed Annuity, Immediate Annuity)

             Level Term Life with Great Smoker Rates  10,15,20,30 Year   (20yr.  issue ages to 65)

              Full Name  *

              Res. Telephone Number  *

              Street Address  *

              City  *

              State  *

              Zip Code  *

               email address *  (Required as most Info & Contracts delivered by email)

              Resident Insurance License Number or NIPR Number

              Cell Phone

              OFFICE Telephone

               Fax Number                          

              Current Website address