Disability Insurance Basics
Rating Insurance Companies

Why should you take out disability income protection insurance?

  • To guarantee income continuity in the event of sickness or accident.
  • To avoid a company having to fund the continuing salary for a disabled employee longer than may be otherwise desirable.
  • To pay the expenses of the business which would continue to be payable in the event of a principal owners disability
     Apply Online for a Quote on Disability Insurance
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What would happen if you were disabled?  Who would take care of your family, or pay your bills?  We can help!  Take a minute to get a FREE no obligation Disability Income Insurance Quote today!  You could save substantially for two minutes of your time

The short form below should be filled out as completely as possible in order to receive an accurate quote.

First Name

 

Last Name

 

Street Address

 

City

 

State

 

Zip Code

 

Day Phone

 

Evening Phone

 

E-mail Address

 

Best time to call:

 

Who is this quote for?

 

Gender

 

Birthday (mm/dd/yy)

  19

Height

 feet inches

Weight

 lbs.

Are you Self - Employed?

 

If ``No", who is your employer?

 

What type of business are you employed with?

 

What is your position?

 

How many years have you been with your current employer?

 

Occupation (IMPORTANT be as specific as possible)

 

Present Monthly Gross Income:

$

Monthly Benefit Requested: (What you will be paid monthly if disabled)

$

Please indicate tobacco use:

 

Do you participate in any hazardous activities?

 

Waiting Period: (time between injury and pay-out)

 

Benefit Period:

 

Please describe your
particular health problems:
(leave blank if none)

 

Please list any medications
and dosage
(leave blank if none)

 

Describe your family's history
of cancer and/or heart disease
(leave blank if none)

 

Would you like an additional quote?

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