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    Because life is not always as certain as your responsibilities...
    Term Life America's Long Term Care Quotes are accurate and to the point!

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Quotes

“Quick Quote Technology”,
Choose your desired plan of Long Term Care Insurance and complete and submit the quote form below!

Long Term Care (LTC)
Quote Proposal Form

 Please Complete "All Of The Information Below"  

Customer Name:
First MI Last
Phone Number: 
(xxx) xxx-xxxx
Email:
Date of Birth:
/ /
Sex:
Height & Weight:
&
Tobacco Use:
Never No Yes
Marital Status :
State of Primary Residence :
Daily Nursing Home Benefit desired :
$
Benefit Period :
Waiting Period Before Benefits Begin :
Include Compound Inflation Protection?:
Yes (recommended) No
Include Home Health Care Coverage?:
 Yes No
Include Spouse Discount? :
Yes No (Spouse discount applies for most companies when both husband and wife apply for coverage at the same time)

Optional Spouse Information
Name : First MI Last
Date of Birth:
/ /
Height & Weight:

 
 &
Best Time To Call:



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Term Life America Insurance
 Long Term Care
888.587.8511
9:00AM - 5:00PM Eastern Time
PO Box 30248
Charleston, SC 29417

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LongTermCare.TermLifeAmerica.com- Lewis Fink is licensed as an insurance agent offering Long Term Care Insurance in the following states: Alabama - AL, Arkansas - AR, Delaware - DE, District of Columbia - DC, Florida - FL, Georgia - GA, Idaho - ID,  Iowa - IA, Kansas - KS, Kentucky - KY, Louisiana - LA, Maine - ME, Michigan - MI, Mississippi - MS, Missouri - MO, Montana - MT, Nebraska - NE, New Mexico - NM, New Jersey - NJ, North Dakota - ND, Ohio - OH, Oklahoma - OK, Pennsylvania - PA, Rhode Island - RI, South Carolina - SC, South Dakota - SD, Tennessee - TN, Texas - TX, Utah - UT, Vermont - VT, Virginia - VA, and Wisconsin - WI.

News!    Helpful Links!     State Insurance Departments!       Health Insurance ► Quote and Apply Online!


Not all Long Term Care Products are available in the appointed states listed above.