COMMUNITY INSURANCE

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*SERVING VISUAL AND PERFORMING ARTISTS AND FAMILIES WITH THE LIFE INSURANCE THEY NEED*

SECURE YOUR FAMILY’S FUTURE

Compare Plans To Your Current Policy

*AFFORDABLE WHOLE LIFE POLICIES

*NO MEDICAL EXAMS REQUIRED

*CRITICAL ILLNESS INSURANCE

*CHILDREN'S LIFE PLANS

*UNIVERSAL LIFE

Please complete the insurance application below to get your free quote.

Name

First Name

Last Name

Date of Birth

YYYY

State of License

Phone Number

Height / Weight

Please list any prescribed medications

What state do you live in?

How much life insurance coverage do you want?

Currency

Desired Monthly Payment

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Have you had any serious health conditions?

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Have you had a Felony or DUI? If so how long ago?

Information Form —

Just complete the secure application form above for a quote for your new life policy or annuity.

Additional Application Information

Please complete the following to complete your application.

Name

First Name

Last Name

Social Security Number

Drivers License Number

State of License

Address

Employer

Job Title

Beneficiary Name, Birthday, Phone

Ex. Richard Johnson, 09/05/1975, 525-323-8979

Mother's Maiden Name

Bank Information- Name, Routing and Account Number

Ex. First National Bank, 039203923, 109833948399

Desired Withdrawal Date for Premium

What state were you born in?

Marcus Rhodes, Licensed Agent

Referrals

Receive retail, restaurant, or gas gift card for each referral that you list!! Receive a $50 gift card for every referral that purchases a new coverage plan!! Just list your name, phone, email, and the referrals, and receive your gift today!

Name

First Name

Last Name

Phone

(###)

###

####

1. Referral Name, Phone, Email

Example - Sally Stewart, 592-293-2737, sstewart@gmail.com

2. Referral Name, Phone, Email

3 Referral Name, Phone, Email

4. Referral Name, Phone, Email

5. Refferal Name, Phone, Email

6. Referral Name, Phone, Email

7. Referral Name, Phone, Email

8. Referral Name, Phone, Email

9. Referral Name, Phone, Email

10. Referral Name, Phone, Email