Attention Agents & Brokers:
Our leads are complete and transmitted to you
within 60 seconds of submission by the consumer! You can
write an app directly from most of our forms. All of our
forms are fully validated - which means the consumer
cannot submit the form until all of the required fields
are completed.
Here is an example Life Lead.
The personal information
has been altered, but this is an actual lead!
Interested in other
types? Click the type: |
auto |
Disability |
health | home
| ltc |
life |
Below is personal information submitted for a quote. It
was submitted by
William Prospect on Friday, January 19, 2008 at 04:04:03
and has been assigned tracking number "MO1105722".
Life Insurance Lead via 4freequotes.com's National
Insurance Directory!
|
========Contact Information======== |
| Name: |
William Prospect |
| Home Address: |
123 e Prospect Street apt. 12 |
| City, State, Zip: |
Kansas city, MO, 64112 |
| County: |
JACKSON |
| Daytime: |
(816) 032-1020 |
| Email Address: |
w.prospect@somewhere.com |
|
========= William Prospect ========= |
|
============Coverage Info========== |
| Death Benefit: |
500000 |
| Type/Term: |
20 Year Level Term |
|
================Underwriting Info============== |
| Proposed Insured: |
William Prospect |
| Gender: |
Male |
| Date of Birth: |
4/9/1951 |
| Height: |
5 Feet, 9 Inches |
| Weight: |
185 |
| Occupation: |
Ballistics |
| Tobacco Use: |
I have Never used tobacco products of any form
|
|
==================Medical History============= |
| Medical Conditions: |
none |
| Other Medical Problems: |
I have had other medical problems |
| Details of Medical Problems: |
orthoscopic knee surgery from a injury
involving a vehicle |
| Ever Been Declined or Rated? |
No |
| Currently taking any Medication? |
No |
| Hospitalized in the last 5 years? |
Yes |
| Details of Hospitalization: |
|
| Ever convicted of DUI/DWI? |
No |
|
=========================================== |
|
|
