Access Brokerage Services – Life Insurance General Agents
Access to the best markets for Life, Long Term Care, Disability Insurance and Annuities!
Phone (631) 473-7244
Home
Quotes
Term Life
Universal Life / Whole Life
Long Term Care
Disability Income
Forms
Annuities
NY Annuity Rates
Underwriting
Underwriting Guidelines
Impaired Risk
Latest News
About Us
Phone (631) 473-7244
Home
›
Universal Life / Whole Life
Universal Life / Whole Life
Fields marked with a * are required
Client Name
Universal / Whole Life
*
Universal Life
Whole Life
Death Benefit
*
Date of Birth
*
Male / Female
*
Male
Female
Tobacco Last Use
*
5 Years or More
4 Years
3 Years
2 Years
None in Past Year
Current Smoker or Within Last Year
Optional: Height
4'6
4'7
4'8
4'9
4'10
4'11
5'
5'1
5'2
5'3
5'4
5'5
5'6
5'7
5'8
5'9
5'10
5'11
6'
6'1
6'2
6'3
6'4
6'5
6'6
6'7
6'8
6'9
6'10
Optional: Weight
Select Rating
Choose best option
Preferred Plus
Preferred
Standard Plus
Standard
Substandard
Agent Name
*
Agent Email
*
Comments / Details
Search for:
Recent Posts
Penn Mutual to Exit New York Market
New York Regulation 187 – Urgent
Genworth Simplifies Long Term Care Health Ratings
New York State Cybersecurity Regulation Filing Deadline
NY Indexed Annuity Cap Raised To 12.05%
Join Our Mailing List!
Leave This Blank:
Leave This Blank Too:
Do Not Change This:
Your email: