Kentucky insurance
kentucky insurance
Insurance Resources for Kentucky Business Owners & Residents
"Find Out Why We Have Been Central Kentucky's
Insurance Sales & Service Leader for over 100 years!"
Kentucky insurance

Kentucky insurance
Kentucky insurance
Visit Our Agency's
Valuable Kentucky
Insurance Resources:

  Home Insurance Quotes
  Auto Insurance Quotes
  Personal Umbrella Quotes
  Watercraft Quotes
  Renter's Ins. Quotes

  Business Owners Quotes
  Workers' Compensation
  Contractor Quotes
  Surety & Fidelity Bonds
  Group Health Quotes

  Life Insurance Quotes
  Health Insurance Quotes
  Disability Income Quotes
  Long Term Care Quotes

  Free Financial Profiles
    & Estate Planning
  Pension Plans
  Business Continuation Plans
  Buy-Sell Planning
  Payroll Deduction Plans

  Service My Account
  Report a Claim
  Our Agency
  Our Customers Say it Best
  Map to Bardstown Office
  Map to Louisville/Metro Office

Questions?
Please Contact
Us Today!

 
You May
E-mail
Us At:

ewco@ewco-ins.com

Phone: 1-502-348-5921
Fax: 1-502-331-0023
Toll Free: 1-800-999-5921

602 Bloomfield Road
Bardstown, KY 40004

KY Insurance License #'s:
354252 and 354251


"All Our Policies Come With an Agent!"
On-Line Life Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data:
 
Your Name:
Street Address:
City:
State: (Must be Kentucky)
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
Unusual Activities?
(If you engage in unusual activities such as scuba diving, airplane flying, rock climbing, etc., list them here.)

Underwriting Information:
 
Name of Insured: Birthdate:
Sex (M/F): Smoker or
Non-Smoker?:
Height: Weight:
 
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.
 
If Term, list years of Level
Premium. (1yr., 5yr., 10yr., 20yr.):
 
List Any Health Problems:
 
Reason for Buying Life Insurance:
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Life Insurance Quote NOW!

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!


Terms of Use/Privacy Notice/Copyright Info. EWCO Insurance LLC.    Design © 2003 Insurance-Web-Sales
Please report site-related technical problems to: ewco@ewco-ins.com (This page last updated 09-10-03)