8 Reasons You Should NOT Even Consider Doing Business With Another Insurance Agent or Direct Writer!
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Underwriting Information:
Name of Proposed Insured:
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Sex (M/F):
Do You Smoke?:
Height:
Weight:
Spouse's Information: (Leave Blank if you do NOT want Spouse Coverage)
Name of Spouse:
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Sex (M/F):
Do You Smoke?:
Spouse Height:
Spouse Weight:
Coverages:
Amount of Coverage Desired?
Type of Life Coverage Desired?
TERM = Pays death benefit only - This is lowest cost for coverage.
UNIVERSAL LIFE = Has savings aspect in addition to providing death benefit.
OTHER = Would be mortgage protection, whole life, no-exam life, etc.
Years of Level Premium, if selecting term life.
List Any Health Problems:
Reason for Buying Life Insurance:
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Contact Us Today at:
Phone: (717) 520-9107
Fax: (717) 520-9308
1231 E. Chocolate Ave.
Hershey, PA 17033
E-Mail us: agent@bbins-online.com
Phone: (717) 520-9107