Shop Term Quote

Cancer

Our online quotes will accurately put you in the “ball park” but ultimately you will choose from insurance plans that are customized to your personal lifestyle and medical history.

One of our experienced, professional, licensed agents will contact you within 24 hours to discuss your options and help you choose an affordable plan that is right for you. If you are ready now, call us toll free at 1-800-264-8114.

When purchasing insurance through Shop Term Quotes Insurance Services,
you are investing in your peace of mind.

Underwriting Questionnaire For Cancer

Complete our fast and easy underwriting questionnaire to receive a preliminary offer in 48-hours or less
Personal Information
Full Name:		Height:
City:		Weight (lb):
State:
Phone:		Occasional Tobacco User:	Yes No
Fax:		Insurance Amount:
Email:		Plan of Insurance:	Term UL SUL
Date of Birth:	mm dd yy	Additional Insured's Name (only if applying for Survivor UL)
Sex:	Male Female
Cancer
Date of diagnosis?
Type of cancer?
Stage?
Type of treatment? Surgery, radiation, chemotherapy.
Date of last treatment?
Cancer can be very difficult to quote on a preliminary basis. If at all possible, obtain a copy of the pathology report. This will greatly increase the chances of giving an accurate quote.
Other information