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Step 2 of 6: Your needs

Term Life Insurance

Term life insurance provides coverage for a set number of years. It is often chosen to help protect a family, a mortgage or an income during working years.

Who needs coverage? *

MyselfSpouseChildBusiness partnerSomeone else

Age or age range *

Under 3030–3940–4950–5960–6970 or older

Desired coverage amount

Under $100,000$100,000 to $250,000$250,000 to $500,000$500,000 to $1,000,000More than $1,000,000Not sure

Desired coverage period

10 years20 years30 yearsNot sure

Primary reason for coverage

Family protectionMortgage protectionIncome replacementBusiness protectionFinal expensesOther

Tobacco use

YesNoPrefer to discuss with the agent

Estimated monthly budget

Under $50 per month$50 to $100 per month$100 to $200 per month$200 to $400 per monthMore than $400 per monthNot sure yet

Desired start date

Additional comments

Your Future. Well Protected.

Insurance Products

Term Life Insurance
Whole Life Insurance
Affordable Healthcare
Dental, Vision and Hearing

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Wells Insurance Group is an independent insurance agency. Submitting information does not guarantee approval, premiums, savings, subsidies or coverage. Plan availability and benefits vary.

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