AN APPLIN FAMILY OWNED AGENCY
HOME
WHO WE ARE
LOCATIONS
STAFF
CAREERS
WHAT WE DO
AUTO
QUOTE
FAQ's
HOMEOWNERS
QUOTE
FAQ's
COMMERCIAL
QUOTE
FAQ's
LIFE
QUOTE
FAQ's
HEALTH
QUOTE
RETIREMENT
GROUP
QUOTE
CLAIMS REPORTING
PARTNERS
PAYMENT OPTIONS
WESTFIELD INSURANCE PAYMENT OPTIONS
CITIZENS INSURANCE PAYMENT OPTIONS
MICHIGAN INSURANCE PAYMENT OPTIONS
PROGRESSIVE INSURANCE PAYMENT OPTIONS
CONTACT US
GET A QUOTE!
AUTO
HOME
BUSINESS
HEALTH
LIFE
GROUP
Health/Life Quote
Life Insurance Information
Type
Primary
Secondary
Amount of Death Benefit
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
1,000,000+
Insured Information
Insured Name
Address
City
State
Zip
Home Phone
Email
Use Tobacco
Yes
No
Gender
Male
Female
Height
Weight
Insured Medical Information
Describe any pre-existing Health conditions
List below any medication, including dosage and frequency
Note any other pertinent information or requests for coverage
Spouse Insurance Information
Spouse to be Insured?
Yes
No
Spouse Use Tobacco?
Yes
No
Gender
Male
Female
Height
Weight
Children
Yes
No
Spouse Medical Information
Describe any pre-existing Health conditions
List below any medication, including dosage and frequency
Note any other pertinent information or requests for coverage
Children Medical Information
Describe any pre-existing Health conditions
List below any medication, including dosage and frequency
Note any other pertinent information or requests for coverage
Disability Insurance Information
Occupation
Duties
Earnings
Earnings Frequency
Weekly
Monthly
Yearly
Other Disability Coverage?
Yes
No
Other Disability Coverage Type
Individual
Group
Disability Benefits to be Quoted
Elimination Period STD
180 Days
90 Days
60 Days
30 Days
Percentage Payable STD
Maximum Monthly Benefit STD
Duration of Benefits STD
Age 65
5 Years
2 Years
Elimination Period LTD
180 Days
90 Days
60 Days
30 Days
Percentage Payable LTD
Maximum Monthly Benefit LTD
Duration of Benefits LTD
Age 65
5 Years
2 Years
* = Required Field
Disclaimer Notice
- The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
Send
15621 S. Telegraph Rd
Monroe, MI 48161
phone: (734) 241-1133
Fax: (734) 241-9275
Monday through Friday
8:30am-5:00pm
CLICK FOR A QUOTE
Dansard-Little Insurance Facebook Page
Insurance News
Alabama Woman Sentenced for Embezzling More Than $600K from Fire Departments
Tue, 20 Aug 2019 13:47:31 +0000
A federal judge has sentenced an Opelika, Alabama, woman to prison for embe...
Read More
The Hilb Group Acquires Tennessee’s Mackie Financial Group
Tue, 20 Aug 2019 13:41:06 +0000
The Hilb Group LLC (THG) has acquired Tennessee-based Mackie Financial Grou...
Read More
The MEMIC Group Appoints Wilson as Senior Production Underwriter in Georgia
Tue, 20 Aug 2019 13:37:14 +0000
Workers’ compensation specialist The MEMIC Group has appointed Kim Wilson t...
Read More
