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What is your height and weight?
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Do you have life insurance now?
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How much?
What type of life insurance are you looking for? Check all that apply. (optional)
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Do you currently smoke cigarettes or e-cigarettes?
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Check all conditions that you’ve been treated for.
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Have you had more than 3 driving violations in the past 3 years?
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Do you currently engage in any of these sports or activities?
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Mountain & rock climbing
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Do you currently engage in any of these sports or activities?
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Did your parents or siblings have heart disease, cancer, stroke or diabetes before age 65?
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Who are we preparing this quote for?
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