Insurance Brokerage From Top Rate Companies

Insurance Brokerage America offers spreadsheet quotes from most of the top rated life insurance brokerage companies and pays general agent commissions! Are you a licensed agent wanting to earn general agent brokerage commissions from most of the top rated brokerage companies?  Learn More About This Brokerage Opportunity >>


Long term care quotes and proposals usually take 5 to 7 working days shopping time.

Long Term Care (LTC) Quote Proposal Form!

Please Complete "All Of The Information Below"  
   Agent Information

Agent Name: First  MI     Last

Phone Number: 
(xxx) xxx-xxxx

Best Time To Call:

Customer Information

Customer Name: First  MI     Last
Date of Birth: / /
Height & Weight: &
Tobacco Use: Never No Yes
Marital Status :
State of Primary Residence :
Daily Nursing Home Benefit desired $
Benefit Period :
Rate Class : Underwriting Overview (click here!)  
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:


Start Here!!

Get The Best Term Life Quote
For Your Client

Insurance Brokerage provides you with the latest technology to search for the best term life insurance quote for your client-

Our brokerage spreadsheet quoting system allows you to examine "by underwriting class" all of our top companies as they apply to your specific client needs.

Download top company life insurance quotes -

Get appointed with the company that best suits your clients needs-

Download top brokerage appointment forms-

Get a state specific term
life insurance application-

Insurance brokerage affords the agent an easy way to access all of the forms for all of our companies.

Request state specific brokerage life application forms-

Mail completed forms to -

  Insurance Brokerage America

  National Marketing
  P.O. Box 30248
  Charleston, SC 29417
  800-406-6303     843-769-9804 fax

Product Information Tools

Carrier Profiles And Links
  Products Information
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  Underwriting Requirements
  Capital Needs Analysis Calculator

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