American Senior

Let's get started with your age:

Most insurance companies base your quote on factors like age, smoking habits and your overall health.

Age

QUESTION 1/13

Do you currently have coverage, already?

Yes

QUESTION 2/13

How much coverage would you like?

The average cost of a funeral in America is $9,400, so it's best to quote for the amount that you need. Anything extra is nice, but only if it's within your budget.

QUESTION 3/13

Who will be responsible for planning/arranging your Funeral?

Spouse

Relative

Child

Other

Question 4/13

What's your favorite hobby?

We use this for security purposes.

Enter hobby

Question 5/13

What is your first name only?

We don't ask for your last name to protect your privacy

Enter First name

Question 6/13

Nice to meet you !

Where can we send you more information?

Street Address

Apartment, Suite, etc

City

State

Zip Code

Question 7/13

In case we have any additional questions, what is the best phone number to reach you?

Your phone number will be your personal password, and helps just in case we have any more questions.

Enter Phone Number

Question 8/13

What's your preferred email address?

Your email address will be used as your username and will be the easiest way to receive policy information.

Email Address

Question 9/13

Tell us a little about yourself:

How tall are you?

Height Ft.

Height In.

Question 10/13

Tell us a little about yourself:

How much do you weigh?

Weight in lbs

Question 11/13

What is your gender?

As mentioned, most insurance companies base your quote on factors like age, smoking habits and your overall health.

Male

Female

QUESTION 12/13

Other than the occasional pipe or cigar, have you smoked tobacco, in the last 12 months?

Yes

QUESTION 13/13