Contact Us At:
101 Edison Furlong Road
Doylestown, PA 18901
Phone: 1-215-489-7601
Fax: 1-215-489-7603
5 Reasons You Should Use the Services of PACarInsurance.com:
1. The best coverage at the lowest price.
2. Instant phone quotes for most products.
3. Low down payments & easy monthly installments on most policies.
4. Internet quotes returned within 24 hours.
5. Rates are shopped with 25+ insurance companies.
Underwriting Information:
Name of Proposed Insured:
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Sex (M/F):
Do You Smoke?:
Height:
Weight:
Spouse's Information: (Leave Blank if you do NOT want Spouse Coverage)
Name of Spouse:
Enter Spouse's Birthdate:
Sex (M/F):
Do You Smoke?:
Spouse Height:
Spouse 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:
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