Ames Insurance

Get a Quote For Life Insurance

Ames Insurance is an independent agency, which means we write insurance for many different companies.  By completing the questionnaire below you will give us the necessary information to offer you an accurate quote.

Fill out this questionnaire completely for a free quote! (or e-mail us and ask us to contact you)

First and Last Name:
Address:

City:

State:

Zip:

Home Phone(with area code):
Work Phone(with area code):
Fax number(with area code):
E-mail address:

Contact us:

Anytime Morning at Home Morning at Work Afternoon at Home Afternoon at Work Evening at Home Evening at Work Weekends

1st Person Data

Full Name	Date of Birth	Height	Occupation
Non-Smoker	Sex M/F	Weight
Yes No	M F

Type of Policy	Coverage amount
Term Permanent  What's This?Term - Provides coverage for a set period of time. If you die after the policy term, a death benefit will not be paid. Less expensive than Permanent. Permanent - Provides lifelong coverage. Builds cash value. More expensive than Term.

2nd Person Data

Full Name	Date of Birth	Height	Occupation
Non-Smoker	Sex M/F	Weight
YES NO	M F

Type of Policy	Coverage amount
Term Permanent  What's This?Term - Provides coverage for a set period of time. If you die after the policy term, a death benefit will not be paid. Less expensive than Permanent. Permanent - Provides lifelong coverage. Builds cash value. More expensive than Term.

Questions / Comments:

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