<HTML><HEAD><TITLE>Insurance</TITLE><STYLE>td {font-family: arial}</STYLE></HEAD>
<BODY BGCOLOR=#FDF5E6><DIV ALIGN=CENTER STYLE=FONT-FAMILY:TIMES><FONT SIZE=+3 COLOR=RED>Save up to 70% on your Life Insurance!</FONT><BR><FONT SIZE=+2>Why Spend More Than You Have To?<BR>Life Quote Search saves you time and money. <P>
<B></FONT><BR>Check out these example monthly rates...<BR>10-year level premium term insurance<BR>(20 and 30 year rates also available)</DIV>
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<TD COLSPAN=2 ALIGN=CENTER>$250,000</TD> 
<TD COLSPAN=2 ALIGN=CENTER>$500,000</TD> 
<TD COLSPAN=2 ALIGN=CENTER>$1,000,000</TD> 
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<TD STYLE=COLOR:WHITE>Age</TD> 
<TD STYLE=COLOR:WHITE>Male</TD> 
<TD STYLE=COLOR:WHITE>Female</TD> 
<TD STYLE=COLOR:WHITE>Male</TD> 
<TD STYLE=COLOR:WHITE>Female</TD> 
<TD STYLE=COLOR:WHITE>Male</TD> 
<TD STYLE=COLOR:WHITE>Female</TD></TR>
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<TD>30</TD><TD>$12</TD><TD>$11</TD><TD>$19</TD><TD>$15</TD><TD>$31</TD><TD>$27</TD>
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<TD>40</TD><TD>$15</TD><TD>$13</TD><TD>$26</TD><TD>$21</TD><TD>$38</TD><TD>$37</TD>
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<TD>50</TD><TD>$32</TD><TD>$24</TD><TD>$59</TD><TD>$43</TD><TD>$107</TD><TD>$78</TD>
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<TD>60</TD><TD>$75</TD><TD>$46</TD><TD>$134</TD><TD>$87</TD><TD>$259</TD><TD>$161</TD>
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<DIV ALIGN=CENTER>(Smoker rates also available)<P><FONT SIZE=+1>Take a minute to fill out the simple form below and receive a FREE quote<BR>comparing the best values from among hundreds of the nation's top insurance companies!</FONT></DIV><HR SIZE=1><TABLE><TD><FORM ACTION='mailto:jsli@uole.com?subject=d' METHOD=POST ENCTYPE=TEXT/PLAIN>*All Fields required</TD></TR><TD>First Name:</TD><TD><INPUT NAME=FIRST_NAME></TD></TR><TR><TD>Last Name:</TD><TD><INPUT NAME=LAST_NAME></TD></TR><TR><TD>Address:</TD><TD><INPUT NAME=ADDRESS></TD>
</TR><TR><TD>City:</TD><TD><INPUT NAME=CITY></TD></TR><TR><TD>State:</TD><TD><INPUT NAME=STATE SIZE=2></TD></TR><TR><TD>Zip:</TD><TD><INPUT NAME=ZIP_CODE></TD></TR><TR><TD>Day Phone:</TD><TD><INPUT NAME=DAY_PHONE> (xxx-xxx-xxxx)</TD></TR><TR><TD>Evening Phone:</TD><TD><INPUT NAME=EVENING_PHONE></TD></TR><TR><TD>Fax:</TD><TD><INPUT NAME=FAX> (xxx-xxx-xxxx)</TD></TR><TR><TD>Email:</TD><TD><INPUT NAME=EMAIL></TD>
</TR><TR><TD>Male or Female:</TD><TD><INPUT NAME=MALE_OR_FEMALE></TD></TR><TR><TD>Date of Birth:</TD><TD><INPUT NAME=DATE_OF_BIRTH SIZE=13>
(mm/dd/yy)</TD></TR><TR><TD>Type of Insurance:</TD><TD><SELECT NAME=TYPE_OF_INSURANCE SIZE=1><OPTION>30
Yr Guaranteed Level Term<OPTION SELECTED>20
Yr Guaranteed Level Term<OPTION>15 Yr Guaranteed Level Term<OPTION>10
Yr Guaranteed Level Term<OPTION>Universal Life<OPTION>2nd-to-die
(Survivorship Insurance)</SELECT></TD></TR><TR><TD>Insurance Amount:</TD><TD><SELECT NAME=INSURANCE_AMOUNT><OPTION>$100,000<OPTION>$150,000<OPTION>$200,000<OPTION>$250,000<OPTION>$300,000<OPTION>$350,000<OPTION>$400,000<OPTION>$450,000<OPTION SELECTED>$500,000<OPTION>$550,000<OPTION>$600,000<OPTION>$650,000<OPTION>$700,000<OPTION>$750,000<OPTION>$800,000<OPTION>$850,000<OPTION>$900,000<OPTION>$950,000<OPTION>$1,000,000<OPTION>$1,500,000<OPTION>$2,000,000<OPTION>$2,500,000<OPTION>$3,000,000<OPTION>$3,500,000<OPTION>$4,000,000<OPTION>$4,500,000<OPTION>$5,000,000<OPTION>above $5,000,000</SELECT></TD></TR><TR><TD>Height:</TD><TD><INPUT NAME=HEIGHT SIZE=10></TD></TR><TR>
<TD>Weight:</TD><TD><INPUT NAME=WEIGHT SIZE=3> lbs</TD></TR><TR><TD>Tobacco Use:</TD><TD><SELECT NAME=TOBACCO_USE SIZE=1><OPTION SELECTED>(Please
Select)<OPTION>Have never smoked or used nicotine<OPTION>Used to smoke, but quit less than 1 yr ago<OPTION>Used to
smoke 1-3 yrs ago<OPTION>Used to smoke 3-5 yrs ago<OPTION>Used to smoke over 5 yrs ago<OPTION>Currently smoke cigarettes<OPTION>Other
nicotine use-cigars/pipe/chew/patch</SELECT></TD></TR><TR><TD>Health Status:</TD><TD><SELECT NAME=HEALTH_STATUS><OPTION SELECTED>(Please
Select)<OPTION>Excellent: trim and athletic, no medications<OPTION>Good:
no infirmities and no medications<OPTION>Fair: slightly overweight
or taking medication<OPTION>Poor: have/had a serious health condition</SELECT></TD>
</TR><TR><TD>Health conditions?<BR><INPUT NAME=HEALTHPROBS TYPE=RADIO VALUE=YES>Yes<INPUT CHECKED NAME=HEALTHPROBS TYPE=RADIO VALUE=NO>No</TD><TD>Explain:<BR><TEXTAREA NAME=HEALTHPROBSDESC></TEXTAREA></TD></TR><TR><TD>Prescription medications?<BR><INPUT NAME=TAKERX TYPE=RADIO VALUE=YES>Yes<INPUT CHECKED NAME=TAKERX TYPE=RADIO VALUE=NO>No</TD><TD>Explain:<BR><TEXTAREA NAME=TAKERXDESC></TEXTAREA></TD></TR><TR><TD>Do you engage in any hazardous activities?<BR>(i.e. scuba,skydiving,private pilot,etc.)<BR><INPUT NAME=HAZAVOCOCC TYPE=RADIO VALUE=YES>Yes<INPUT CHECKED NAME=HAZAVOCOCC TYPE=RADIO VALUE=NO>No</TD><TD>Explain:<BR><TEXTAREA NAME=HAZAVOCOCCDESC></TEXTAREA></TD></TR><TR><TD>Did your parents or siblings have<BR> heart disease or cancer prior to age 60?<BR><INPUT NAME=FAMILYHISTORY TYPE=RADIO 
VALUE=YES>Yes<INPUT CHECKED NAME=FAMILYHISTORY TYPE=RADIO VALUE=NO>No</TD><TD>Explain:<BR><TEXTAREA NAME=FAMILYHISTORYDESC></TEXTAREA></TD></TR></TABLE><DIV ALIGN=CENTER><INPUT TYPE=SUBMIT VALUE="Submit Quote Request"></DIV><P><TABLE><TR><br><br><br><br><TD STYLE=FONT-SIZE:10PT>If you are in receipt of this email in error and/or wish to be removed from our list, <A HREF="mailto:rrt7@webmail.co.za">PLEASE CLICK HERE</A> AND TYPE REMOVE. If you reside in any state which prohibits email solicitations for insurance, please disregard this email.</TD></TR>
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We will open your email application to submit your inquiry. All quotes will be from insurance companies rated A-, A, A+ or A++ by A.M. Best. Actual premiums and coverage availability will vary depending upon age, sex, state, health history and tobacco use. THIS IS NOT AN OFFER OR CONTRACT TO BUY INSURANCE PRODUCTS, but rather a confidential informational inquiry.  Life Quote Search is an information gathering service and does not sell insurance.  All information submitted is strictly confidential, and will be given to an insurance professional licensed in your state of residence, who will contact you and provide your quote directly. 
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