Smart Family Assurance

Life Insurance Programs For Smart Parents

Qualify For Life Insurance With This 30 Second Quiz!

Do you currently have Life Insurance? *

No

Yes

What is your gender? *

Female

Male

Have you used Tobacco Products within the last 12 months? *

No

Yes

Which state do you currently reside in? *

Florida

Georgia

Michigan

New York

Texas

Why are you looking for life insurance? (select all that apply) *

Protect a debt (ie. mortgage or medical bills)

Cover end of life expenses such as funeral costs

As income replacement

Leave money for my family

Leave money to an organization, such as a personal business or charity

Other

In the past 5 years have you been treated or prescribed medication for any of the following conditions? (select all that apply) *

I have no medical conditions

Anxiety / depression / bipolar

Heart or circulatory disorder

Cancer

Respiratory disorder

Chronic pain

Other medical condition

Diabetes

High blood pressure

Are you currently employed? *

Currently employed

Stay at home

Student

Retired

Unemployed

Disabled

Military

What is your birth year? *

First Name *

Last Name *

Email *

Phone *

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