Equal Health - Health Insurance For Everyone

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1-866-827-5057

Equal Health^sm is determined to help you find a healthcare solution you can depend on and afford. We have licensed agents in many states who can help! To receive your FREE, no obligation quote, simply complete the QUOTE REQUEST FORM below. Once submitted, you will be contacted within hours, if not sooner, in order to go over your options. IMPORTANT! Please fill out the form as completely as possible to avoid delay. This will allow us to look at all of your options in greater detail and will make the overall process quicker!

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QUOTE REQUEST FORM


First Name:	*
Last Name:	*
Address:
City:
State:		Currently not available in CA, UT, VT, MN, IL, NV, KS, FL and MT
Zip Code:
E-mail:	*
Primary Phone:	*
Secondary Phone:
How did you hear about us?
Best time to call:
Gender
Are you looking for you or your family?
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Are you a business owner?		Yes No
Are you looking to insure you and your employees?		Yes No
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Age of Adults:		Male: DOB (MM/DD/YY):
		Female: DOB (MM/DD/YY):
How many children?
Tobacco Use:		Male:
		Female:
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Are you currently insured?		Yes No
If you are currently insured, what is your monthly premium?		$
If you are currently insured, what is your current deductible?		$
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If you are not currently insured, what is your (realistic) target premium?		$
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Promo Code - Take-One:
* Required

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ALL RIGHTS RESERVED. © COPYRIGHT 2008 EQUAL HEALTH & LIFE

Equalhealth.com is the website for Equal Health & Life, Inc., an insurance agency licensed in TX, FL, MD, WA, TN, NV, MI, IL OH, WY, KS, MO & GA, but works with licensed insurance agents in most states. Equal Health & Life is currently offering insurance products, in those states, underwritten by Standard Life, Guaranteed Trust Life, Assurant Health, AIG & Humana. Healthcare programs and insurance plans vary by state and may not be available in certain areas. Equal Health & Life does not offer insurance to consumers in the following states at this time: CA, NC, UT, VT, MN, IL, NV, KS, FL, WA and MT.