"The truth is that during the course of your career, you are three and a half times more likely to be injured and need disability coverage than you are to die prematurely and need life insurance."
- Health Industry Association of America


"In the last 20 years, deaths due to the "big three" (cancer, heart attack and stroke) have gone down significantly. But disabilities due to those same three are up dramatically! Things that used to kill, now disable."
- National Underwriter


"Nearly half of the one million Americans who filed for bankruptcy protection in 1999 did so after being sidelined by an unexpected illness or injury."
- New York Post

To learn more about these new disability insurance opportunities, please complete the information below.

 

The information you provide is kept private and confidential.  It will only be utilized to respond to your request and will not be disseminated in any manner.


*Name:  
*Address:  
*City, State, Zip:  
*Date of Birth  
*Income Range  
*E-mail:  
*Phone:  
*Preferred method of contact  
(*Required)    
     
     
I am interested in learning more about: (click all that apply)
  Taking advantage of the opportunity to increase my disability insurance
  Disability Income Retirement Security policy to replace my lost pension and retirement plan contributions
  A complete review of my existing disability insurance
  Whether my existing disability insurance benefits will be taxable income to me
     
Existing coverage:    
  Group LTD/Employer Sponsored  
  Monthly benefit or percentage of earnings
  Elimination period
  Benefit period
  Employer paid?
  Is the premium included in your income
     
  Personal Coverage  
  Monthly benefit
  Elimination period
  Benefit period
  Employer paid?
  Is the premium included in your income
 
Notes: