Life Quote

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Life Quote

Fill out the form below to receive a Quote for Life Insurance.

Your request will be directed to the Client Service Centre closest to you, and an Insurance Advisor will be in touch as soon as possible to provide you with your Quote.

Life Quote

Please fill out this form as completely as possible. One of our experienced Insurance Advisors will review the information and be in touch with you as soon as possible. Thank you for choosing APREID for your Insurance needs.

Name*
FirstLast
Address*
Street AddressAddress Line 2CityProvincePostal Code
Email*
Phone*
Which store is closest to you?*
How did you find APREID?*
- Community Event
- Current Customer
- Facebook
- Internet
- Prior Customer
- Radio (Specify Below)
- Referral (Specify Below)
- Yellow Pages
- Other (Specify Below)
If Radio, which station?
If Referred; who referred you?
Other (Please Specify)
Indicate if you are a member of one of our Group Programs
Your Occupation
Date of Birth (YYYY-MM-DD)
Gender
Amount of Insurance desired?
Other (Please Specify)
Smoking Habits
Do you take part in Car/Watercraft/Motorcycle racing or any other extreme/hazardous sports?
If Yes, what sports?
Do you currently have Life or Mortgage Insurance?
If Yes, list amount of coverage and term
Have you ever had Life Insurance cancelled, declined or rated?
If Yes, why?
Do you have any health conditions?
If Yes, which conditions?
I understand that this is the basic information required to provide a quotation. A quotation is not a guarantee that I am insurable, or that my policy won’t be “surcharged” due to any medical condition that might exist. I understand that if I accept this quotation, I will have to complete a full application and undergo any medical tests required. I also understand that the degree of medical requirements is based on the general medical questions I answer and the amount of insurance I require.*

Life Quote

Life Quote

Toll Free from Anywhere

310-4040