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Life Insurance Quote Request Form

Prefer to run your own quotes?  You can access our quote engine from Applications, Contracting, Forms, and Run a Quote.

Financial Advisor:

APPLICANT INFORMATION

Applicant's gender:
Recent insurance labs positive for nicotine (cotinine)?
Recent insurance labs positive for THC?

LIFE INSURANCE CASE DESIGN INSTRUCTIONS

Level term options to quote:
Guaranteed UL options:
GUL coverage guaranteed to age:
Riders - Waiver of Premium

CARRIER SELECTION & UNDERWRITING CLASS DETERMINATION

We'd like to provide you with the most accurate pricing assessment and point you to the best carrier for your client. Maybe we can even prequalify them for exam and lab-free underwriting! The more info we have up front, the more accurate our preliminary pricing assessment and carrier recommendations.
Blood pressure controlled with medications
Cholesterol controlled with medications
Diabetes
For significant diabetes with complications, ask us for our diabetes underwriting questionnaire.
Diabetes type
Please include any professional associations, certifications, licenses, lifetime experience, annual hours, where the activity takes place, including in any foreign countries etc.
Max. file size: 50 MB.

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CA Corp. Insurance License: 0E02059

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Email
 Mailing & Overnight Address

CPS Advantage
6444 E. Spring Street #287
Long Beach, CA 90815

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