Personal and Commercial insurance to our friends and neighbors
for over 40 years

McGee and Noto Agency - 1819 E. Ridge Road - Rochester, NY 14622 - 585-342-4920


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Life Insurance Quote

YOUR PERSONAL DATA
   
Name:  
Property Address:  
City:  
State: (Must Be NY)  
Zip Code:  
E-Mail (REQUIRED):  
E-Mail again for accuracy:  
Phone:  
Fax (optional):  
Marital Status:   Currently Insured?
Single Married   Yes No
If currently covered list carrier, # of years covered, and type of coverage.  
Unusual Activities
(If you engage in unusual activities such as scuba diving, airplane flying, rock climbing, etc., list them here.)
 

UNDERWRITING INFORMATION
Name of proposed insured:  
Enter Insured's Birthdate:  

Gender:

Male Female  

Do You Smoke?

No Yes
Height:   Weight:
SPOUSE'S INFORMATION
(Leave Blank if you do NOT want Spouse Coverage)
Name of Spouse:  
Enter Insured's Birthdate:  

Gender:

Male Female  

Do You Smoke?

No Yes
Height:   Weight:
COVERAGES
Amount of Coverage Desired:  
Type of Coverage
(Term, Universal life, Other):
 
TERM = Pays death benefit only - This is lowest cost for coverage.
UNIVERSAL LIFE = Has savings aspect in addition to providing death benefit.
OTHER = Would be mortgage protection, whole life, etc.
Years of Level Premium  
List Any Health Problems:  
Reason for Buying Life Insurance:  
Send my quotation via:   E-mail Fax Regular Mail
Call Me By Phone


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