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Life Insurance Lead Sample


Lead Id:435702
Date:Aug 24, 2004 8:19 PM
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Lead Information
Name
Bill Smith
Address
123 Main St
City
Chicago
State
IL
Zip
60604
Email
billsmith@email.com
Day Phone
312-555-1212
Evening Phone
312-555-1213
Contact Time
Evening
Currently Insured
No
Preexisting Conditions
Has Conditions
Prescription Medications
Takes Medications
Life Insurance Questions
Tobacco Usage
Never
Coverage Amount
1800000
Term Length
10 Years
Health Class
Preferred
Licensed Pilot?
Yes
DUI in past 5 yrs?
No
Convicted of Felony?
Yes
Hazardous occupation?
No
Applicant Information Spouse Information
Date of Birth
06/30/64
Gender
M
Height
5' 11''
Weight
280
Smoker
Y
Date of Birth
12/24/69
Gender
F
Height
5' 5''
Weight
200
Smoker
Y
Dependents
Date of Birth Gender
1
 07/15/96 M
2
 08/12/97 F
3
 07/01/98 F