Do you currently have life insurance?
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Yes
No
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How fast do you need the insurance you are looking for?
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Today
Within 24 hours
More than 24 hours
A week or more
I'm just browsing
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Price is always important, but what best describes you when shopping for insurance?
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Cheapest Price And Cheapest Coverage
Combination of Lowest Price For The Coverage
Coverage For My Assets Are The Most Important Above Price
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Would you be the happiest if we had a short conversation and then spent a couple hours finding you the best insurance?
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No
Yes
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What is your first name?
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What is your last name?
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What is your date of birth?
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Marital Status
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Divorced
Married
Partner
Seperated
Single
Unknown
Widowed
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Partner or Spouse: Full Name
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Partner or Spouse: Date of Birth
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Do you live or own property in the state of MA or NH?
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Yes
No
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What is the address?
Address
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Street Address
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City
State
Postal code
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Do you have any pre-existing conditions?
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No
Yes
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How many years do you want the insurance for?
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What dollar amount of coverage are you looking for?
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Year, Make, and Model of All Vehicles and Crafts that you keep in in MA or NH for at least 6 months of the year
Best way to reach you to have a 5 minute conversation?
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Call
Text
Email
Best times of day to reach you?
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I'm flexible
Morning
Around Noon
Afternoon
Evening
What is your email address?
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What is the best phone number to reach you?
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