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Step 2 of 6: Your needs

Whole Life Insurance

Whole life insurance is designed to stay in force for life and may build cash value over time. It is often used for final expenses, legacy planning or permanent family protection.

Who needs coverage? *

MyselfSpouseChildBusiness partnerSomeone else

Age or age range *

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

Primary objective

Final expensesPermanent family protectionEstate or legacy planningCash-value accumulationBusiness planningNot sure

Desired coverage amount

Under $25,000$25,000 to $50,000$50,000 to $100,000$100,000 to $250,000More than $250,000Not sure

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

Tobacco use

YesNoPrefer to discuss with the agent

Do you currently have life insurance?

YesNoNot sure

Desired start date

Additional comments

Your Future. Well Protected.

Insurance Products

Term Life Insurance
Whole Life Insurance
Affordable Healthcare
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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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