LifeandHealth-NH.com - Fast and Free New Hampshire life and health Insurance Quotes
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Life and Health-NH.com - Fast and Free New Hampshire life and health Insurance Quotes

Life and Health-NH.com - Fast and Free NH life Insurance Quotes
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An Online Service
of Immanuel Insurance
Agency, Inc.

"Thanks for visiting our agency's website! Low rates, quality service, and top rated, insurance companies make our agency's life & health insurance plans unbeatable. Get a quote today!"

 
Immanuel Insurance Agency, Inc.
3 Brittany Lane
PO Box 300
Barrington, NH 03825

Phone: 603-335-4300
Toll Free: 800-464-5960
Fax: 603-822-7101
Email:
david@immanuelins.com

  NH life insurance quotes    

EASY QUOTE REQUEST
On-Line Life and/or Health
Insurance Quotation Form
One Simple Form - takes only 2-3 Minutes!
WE SHOP OVER 40+ COMPANIES FOR YOU!


Your Personal Data:
 
Your Name:
Street Address:
City:
State: (Must be New Hampshire)
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
Primary Insured's Occupation:
 
Are You Married?
Yes No
Currently Insured?
Yes No
 
If currently covered list carrier, # of years covered, and type of coverage
 
Unusual Activities?
(If you engage in unusual activities such as scuba diving, airplane flying, rock climbing, etc., list them here.)


Underwriting Information:
 
Name of Proposed Insured:
Enter Proposed Insured's Birthdate:  
Sex (M/F): Do You Smoke?:
Height: Weight:
 
Spouse's Information:
(Leave Blank if you do NOT want Spouse Coverage)
 
Name of Spouse:
Enter Spouse's Birthdate:  
Sex (M/F): Do You Smoke?:
Spouse Height: Spouse Weight:
 
Children/Other Dependent Information:
(Leave Blank if you have no children or dependents)
How Many Children or Dependents to Cover?: List their Names & Dates of Birth (i.e.: 07-10-02) In This Box:
 



Coverages:

What Kind of Coverage Shall We Quote?
 



QUESTIONS FOR LIFE INSURANCE:
(If you only want health insurance, skip this section.)

Amount of Coverage Desired?
 
Type of Life Coverage Desired?
 
TERM = Pays death benefit only - This is lowest cost for coverage.
UNIVERSAL LIFE = Has savings aspect in addition to providing death benefit.
OTHER = Would be mortgage protection, whole life, no-exam life, etc.
 
Years of Level Premium, if selecting term life.
 
List Any Health Problems:
 
Reason for Buying Life Insurance:
 
If a Group Plan Please Answer the Following:
(Leave Blank if this life or health plan is an individual plan)
Number of Employees: # Employees currently enrolled in your group plan:
What Kind of Group Coverage Shall We Quote?
 
Please tell us about your current group coverage (carrier, coverages, benefits, etc.):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone


Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Health Insurance Quote NOW!


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Life and Health-NH.com's health and  life Insurance Quotes Our Goal:
Life and Health-NH.com is a New Hampshire insurance agency with highly qualified professionals committed to finding the best coverages and prices for your health Insurance needs.

How to Locate Our Agency:
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