Get Quotes

Quotes on Health Insurance  (including Supplemental policies, like Cancer, Critical Illness and Accident)

Quotes on Life Insurance

Note all companies provide means for online quoting, in order to provide you with a wider variety of quotes, you may fill out the appropriate form and we will quickly send you an email with quotes from multiple companies. 

NOTE:  I am an independent insurance agent.  This form goes only to me, not to 100 other agents who will all try to call you everyday for the next year or send you an endless emails. 

I will need your email address in order to email you the quotes.  I will NOT give or sell your email address to anyone else.  

For those who are so desire I have included several boxes in the form below if it makes you feel more at ease. One box, if you so chose and select it, I will only send you one email, the quotes you request, then I will delete your email address.   The only way to proceed would be for you to contact me.  The other box you can select if you want me to fax you one time with the quotes, and another box if you want me to call you and give the quotes over the phone.  If you select the later two, you do not need to give out your email address, but, you will need to give me your phone number (fax or voice). 

Health Insurance Quote Request Form

To give you a quote I will need the following information.

First Name    Last Name

Zip Code (Insurance companies base rates on Zip, this is important)

eMail Address   
   request for us to email only quote, then delete your address
Phone #:    Cell #   FAX
   request to call # and give quotes over phone, and not by email
   request to FAX quotes and not send by email (must give FAX #)

How Many To Be Insured    Self        Self & Spouse      Number Children

Your Age     Spouse's Age
List Ages of Children (separate with comma)

Have you used tobacco products in past 12 months? Yes    Spouse ? Yes

Your Wt   Ht         Spouse's Wt    Ht
List Wt/Ht of each child, separate children with comma (4' 7"/95, 5' 2"/120)
 

Do you currently have health coverage ? Yes
  Who is it with?     What is Deductible?
  What is monthly Premium?

Does anyone have any type of pre-existing medical conditions or currently on medications (if so, give as Self, Spouse or Child1, etd, medical condition, and current medications)?

Are there any Specific things you are looking for in a (new) policy? Specific benefits or cost limits?  Give any other comment here:

 

Life Insurance Quote Request Form

To give you a quote I will need the following information.

First Name    Last Name

Zip Code (Insurance companies base rates on Zip, this is important)

eMail Address   
   request for us to email only quote, then delete your address
Phone #:    Cell #   FAX
   request to call # and give quotes over phone, and not by email
   request to FAX quotes and not send by email (must give FAX #)

 Age    Wt    Ht   

Have you used tobacco products in past 12 months? Yes    Spouse ? Yes

What type of Life Insurance are your seeking? 
Term    Mortgage Term   Permanent: Whole Life    Universal Life

What amount should we quote (we will give higher and lower then this amount as well)
    

Do you have pre-existing medical conditions or currently on medications (if so, give list medical conditions, and current medications)?

Are there any Specific things you are looking for in a life insurance policy?  Give any other comment here:

james beals - licensed agent

Agent: James Beals
State of New Mexico
Life, Health & Annuity Insurance Lic# : 212879
National Producer's # : 8196228
505-299-0254
Email :