Steve Elrod & Associates, Inc.

 P.O. Box 787   Bainbridge, GA 39818   800-562-0703   229-246-1685   E Mail
Request for Proposal for Life Insurance
You are at no obligation to buy anything. Your request for a quote and your privacy are respected.
Please review the Type of Coverage.
Term Life Insurance
Just as the name of this product describes, the coverage is good for a certain period of time, or better put, a TERM. This is a very practical insurance purchase to cover temporary and high expense needs such as debt, assuring income for a young family, college expenses, mortgages, and any other type of financial need for a specific period of time (Term). Term life insurance is very low cost because term is considered temporary coverage, and more than likely you will out live the term of the coverage.
Permanent Life Insurance
Again, just as the name implies, this life insurance is for your permanent needs. For example: burial and final expenses in life, care of a surviving spouse. This coverage guarantees you the same coverage for life, and the premiums never change. It's Permanent! Permanent Life Insurance costs more than term because the coverage remains in effect for your entire life at the same premium as when the policy is issued. It is a good idea to have at least enough permanent life insurance to cover your funeral cost. This can be purchased for you, your spouse, children, and grand children.

Please complete the areas below
First Name
Last Name
Your e-mail Address
Date of Birth
Gender Male     Female
Tobacco Use? Yes     No
Are you employed in one of our groups now?     If so, Employer?  
Choose Insurance Type     Term Life     Permanent Life
State in which you reside    
Amount of Life Insurance  
Request Payment Method/Frequency:
Payroll Deduction   Monthly Bank Draft   Direct Qtr Bill   Direct Semi Annual Bill   Annual Bill
Please describe your current and past health history in brief.
Please state if your health is considered to be good or excellent.
If other than good or excellent, please give a brief description below.
Please choose how would you like us to present your quote to you?
By e-mail - E-mail address...
By mail - Mailing address...
Please have an agent call
My Home   My Cell   My Work
Best Time to Call  
By fax - Fax number...
**Please remember fax machines are often located in general areas where anyone could see your information.
Our print out will show name and age.
Response time will vary depending on our work load. You should expect your quote in one to three days.