from Special Plans of Tennessee
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Name: Optional Please type in John Doe
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Do you smoke cigarettes?
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What is your height?
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What is your weight?
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What prescription drugs do you now take?
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What dollar amount of life insurance do you need?
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What Type of Life Insurance Do You Want Quoted?

Term Insurance: Enter time desired below
10yr - 15yr - 20yr - 25yr - 30yr
Permanent Insurance: Whole Life /Universal Life
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• Phone 865-769-3772 / Toll Free 888-225-8556 / Fax 865-769-3753 •