Life – Kelly Assurance

Life Insurance Quote Form

Life insurance is a contract between an insurer and a policyholder in which the insurer guarantees payment of a death benefit to named beneficiaries upon the death of the insured. The insurance company promises a death benefit in consideration of the payment of premium by the insured.

Please fill out the form below and we’ll have an agent reach out to you as soon as possible. Thanks

First Name

Last Name

Street

City

State

ZIP/Postal Code

Primary Phone Number

Alternate Phone Number

Date Of Birth

Gender

Height

Weight

Tobacco used (Y/N)

Coverage Amount

Length of Coverage in Years (5-Whole Life)

Coverage Period

Premium Payment

How did you hear about us?

The information on this website is not intended to be exhaustive nor should any discussions or opinions be construed as legal advice

– it is intended for educational and/or informational purposes only.

Kelly Assurance not only protects your company from major risks, we also take steps to potentially reduce and eliminate losses before they occur.

We aim to migrate your risks through proactive education, strategy calls, and loss control programs.

Once you become a client at Kelly Assurance, you’ll have the on support of a dedicated Kelly Assurance service team staffed with licensed professionals who know your business.