Life Insurance Needs Estimator

QuickQuote Term Life Insurance Estimator

Welcome to the QuickQuote Term Life Insurance Estimator. To obtain your estimate you will need to spend about 2 to 10 minutes to fill in the following financial data. The time you spend will depend on the amount of information you have readily available. Please provide as accurate information as possible.

We will start by asking you about your family then proceed to asking you about your current assets and liabilities. The QuickQuote Term Life Estimator will then recommend the amount of term life insurance you need and the length of time the policy should cover.

Privacy Policy	General Information
Age Marital Status Single Married Number of children Number of other dependents Years until last dependent is independent Weekly Net Income (Take Home Pay) Years of Income Replacement

Asset Information

Please fill in any areas in which you have assets. Check any assets you wish to liquidate upon death.

Cash (checking / savings) N/A Value of Home (if applicable) Investment Accounts (Bonds/Stocks/Mutuals) Existing Life Insurance N/A Business Other Assets Pension Funds (401(k)/IRA/Keogh) Social Security N/A

Liability Information

Please fill in any areas in which you have liabilities.

Mortgage Balance (if applicable) Years Left on Mortgage (if applicable) Installment Debt (auto, furniture,...) Credit Cards Funeral Expenses Business Debts (Sole Proprietor...) Personal Notes / Other Liablities