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Life Insurance
at Zeller Insurance Agency

Please note that entering information here does not initiate your coverage by Zeller Insurance. You are still required to fill out the necessary paperwork to begin coverage.

* denotes a required field.

Term Life Insurance Quote

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Information About Yourself

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Male Female

Married Single

Yes No

Yes No

Yes No


Information About Your Spouse

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Male Female

Yes No

Yes No

Yes No


 
Information About Your Children

 
Additional Comments

Note: By submitting this form you understand that no coverage is bound until you receive written notice.

Privacy Statement and Credit Scoring

At Zeller Insurance Agency, Inc. we take your personal privacy seriously. We may collect non-publicized personal information about individuals or businesses in the course of doing business. Please read on to understand why and how we collect and use this information, in addition to how we protect the confidentiality of that information.

Information Compilation and Use

We gather and use personal information in order to properly and effectively provide and service our insurance products. For example, we may use nonpublic personal information to underwrite insurance policies, process policy claims, or facilitate various billing procedures.

We may gather information from:

  • You, on an application or other forms. Information we collect could include names, address, social security number and driver's license numbers.
  • Your dealings with us, such as payments of premiums or submitting of claims.
  • Other third parties, such as doctors, employers, and other insurance companies. Information we collect may include medical records, employment history, payment and claim history.
  • Credit reporting agencies, government agencies, insurance reporting agencies and medical information providers.

Information Disclosure

We do not sell nonpublic information to anyone. We do not disclose nonpublic personal information to our affiliates or to any nonaffiliated third parties, except as required by law.

Thank you for choosing Zeller Insurance Agency, Inc. We appreciate the trust that you place with us. We value your business and appreciate the opportunity to service your insurance needs today and in the future.


 

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