InsureNOW Direct Contact Us Thomas Costante 2454 Minton Rd Melbourne, FL 32904 (321) 725-8100 tcostante@thefloridahealthinsuranceexchange.com www.thefloridahealthinsuranceexchange.com Compare Term Life Insurance Rates At No Cost From Top-Rated Companies In Seconds. Coverage Amount * Calculate Length of Coverage Select Length of Coverage1 Year Products10 Year Products15 Year Products20 Year Products25 Year Products30 Year Products * Birth Date (mm/dd/yyyy) * Gender GenderFemaleMale * Height Feet4567 Inches01234567891011 * Weight (lbs.) * First Name * Last Name * Phone * State Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming* Email * How often do you use nicotine-based products? SelectNeverCurrent UserNone in the Last YearNone in the Last two YearsNone in the Last three YearsNone in the Last four YearsNone in the Last five Years* Tobacco Types Cigarette Cigar Pipe Chew/Dip Snuff Nicotine Past cigars smoked per year SelectLess than 12 per year12-24 per yearMore than 24 per year Past cigarettes smoked per day SelectLess than ½ pack per day1 pack per day2 packs per dayMore than 2 packs per day Have you had family members (parent or siblings) diagnosed with Cancer, prior to age 70? SelectNoYes * Add Row Relationship Age of Onset Diagnosis Have you had family members (parent or siblings) diagnosed with Cardiovascular Disease, prior to age 70? SelectNoYes * Add Row Relationship Age of Onset Diagnosis By submitting this request, I consent to receive contact from The Florida Health Insurance Exchange. * Required The Life Insurance Companies We Represent Include… Enter Info Compare Rates Request Application Need Help? >> Frequently Asked Questions >> Life Insurance Calculator Terms and Conditions of Use Copyright ©
