Instant Life Insurance Quote
Your Resident State: 
Your Resident City: 
Your Name: 
Daytime Phone Number: 
Please list any questions or specific areas of interest. 
E-mail Address: 
Birthdate: 
Gender:  Male     Female 
If you use tobacco, other than cigarettes, check "No" and use the
Health Analyzer on the Results Page. There may be discounts available.

Smoker/Tobacco:
 



Yes    No 
 Select Level Rate Guarantee Period From Drop-Down Menu:   
There are discounts at $100,000, $200,000, $250,000 and $1,000,000. If
you are looking at $150,000, for example, get a quote for $250,000. That
may be a better value. Likewise, at $750,000, get a quote for $1,000,000.

Face Amount:
 




Do you want a policy now or just shopping?  Interested Now     Just Shopping 
We are always trying to improve the educational part of AmericaQuote
so we're doing an informal survey. Please contribute your thoughts.
We value your input. What aspect of life insurance or the life
insurance buying process do you find most confusing? 



When you click "Compare Now," you will see the best-possible health category.
To see if you may qualify for those rates, use the "Health Analyzer" to narrow down your options.
There are other health and lifestyle rules not listed in the "Health Analyzer" that may impact any final underwriting decision.
It's best to call us at AmericaQuote and discuss your situation for a better underwriting analysis.
1-800-542-5530