The Keith Agency, Inc.
 
Because We Care 

              3464 N. Jefferies Hwy.                                                           Office: (843) 539-1133

                   PO Box 320                                                                            Fax: (843) 539-1136   

             Walterboro, SC 29488                                                          Toll Free: (800) 328-9425
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Home      Life Insurance Quote
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ONLINE QUOTE REQUEST FORM FOR LIFE INSURANCE:
 
 
Life insurance is not a "one size fits all" product, and should always be considered protection, first and foremost.  If you have the permanent kind, later it can become a tax-free source of cash.  Something as important as planning for the protection of your loved ones should be tailored to your unique goals and financial situation, protecting them now and in the future.   
 
Based upon your answers to the questions below, we will design a policy that is suited to your financial needs, and by comparing the rates and benefits of leading life insurance companies, we will find the one best suited to you.  After you answer the questions below, we will have the quote completed and ready for your review within 1 to 2 business days, and will contact you to answer any remaining questions.
 
The questionnaire is very user friendly and not all fields below are required, but the more information you provide, the more effectively we can help you.
 

Contact Information:
Questionnaire: The more complete the more accurate the quote.
If you own life insurance now, how much protection is:
Do you have any type of self-employment income, either part-time or full-time?


Do you prefer to have a life insurance policy that will grow in benefit each year to try to keep pace with increasing financial need?


Do you prefer to have a life insurance policy that starts off with a lower premium now and have the cost increase every:




Do you prefer a policy that has an inflation benefit built into it, giving you a stable premium over a longer period of time, and the potential for tax-free cash accumulation?


Is it important to protect your assets and income for:






In order for us to offer you the best possible rates, please answer the following health questions about yourself. If you prefer we discuss these over the telephone, then scroll to the bottom of the page and hit the “Submit” button. We will contact you within 1 business day by phone and go over these questions at that time.
What is your:
Have you ever used tobacco or nicotine in any form?


If yes, when and for how long?
If you have been treated in the last 10 years for Cancer, Stroke, Heart Disease, Diabetes, High Blood Pressure, or any Blood Disorder, please list below:
If you are currently taking medications of any kind, please list below:
If you are married or have a domestic partner and you want your quote to include coverage on him/her, please answer the health questions for your spouse/partner.
Has he/she ever used tobacco or nicotine in any form?


If yes when and how long.
If you have been treated in the last 10 years for Cancer, Stroke, Heart Disease, Diabetes, High Blood Pressure, or any Blood Disorder, please list below:
If you are currently taking medications of any kind, please list below:
Please click "Submit" and we will get to work preparing your life insurance quote. It will be ready in 1 to 2 business days. Thank you, L. Wayne Keith.