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Who We Are
Products & Services
For Clients
Get a Quote
Resources
- Market Watch
- Financial Charts
Locations
Contact

Get a Quote

Quote Request Form (1)

Please select what type of custom quote you would like us to provide. (* denotes required)

Select Type of Quote:*
Personal Information
Name*
First Last
Address
Street Address City State ZIP Code
Phone*
Email
Life Insurance Policy Information
Select desired Death Benefit:
What type of policy are you looking for?
How long do you want the policy to be in effect?
Tell Us About Your Work
What is your Occupation?
Describe your daily duties:
Do you own a business?
- Yes
- No
Estimate Your Current Monthly Income:
Is Disability Insurance part of your benefit package?
- Yes
- No
Disability Policy Information
Disability insurance helps replace income lost because of an accident or illness. One survey found that 43% of people aged 40 will suffer a disability of at least 90 days before they reach age 65. – 2000 Field Guide, National Underwriter
How much of your income do you want disability insurance to replace?
If you become disabled, what's your desired waiting period before benefits begin?
If you become disabled, how long do you want to be eligible for benefits?
Long-Term Care Policy Information
One of the greatest potential risks faced by America’s elderly is the need for long-term care. Long-term care insurance transfers a portion of the risk of long-term care expenses to an insurance company helping to protect you and your family from potentially devastating expenses.
What daily benefit would you like your long-term care policy to provide?
If you need long-term care, what's your desired waiting period before benefits begin?
If you need long-term care, how long do you want to be eligible for benefits?
- Lifetime
- 3 Years or More
- 12 to 35 months
Do you want your policy to include home-health care coverage?
Do you want your policy to have the option to increase with inflation?
Briefly describe any medical events in the past 10 years that have required hospitalization or surgery:
Would you like to include a spouse?*
- Yes
- No
Spousal Information
Name*
First Last
Address
Street Address City State ZIP Code
Phone*
Email
Date of Birth:
Gender:
- Male
- Female
Height:
Weight:
Spousal Long-Term Care Policy Information
Additional Information
Are you a tobacco user?
- Yes
- No
Are you a pilot?
- Yes
- No
How would you describe your current health?
Any additional information we should consider while processing your request?
401(k) Plan Information
The most common employer-sponsored retirement plan is the 401(k) plan. The 401(k) plan is a defined contribution plan. It allows employees to make pre-tax contributions, and the funds contributed plus any earnings accumulate tax deferred.
When would you plan on implementing your new 401(k) plan?
How many employees would be eligible for the 401(k) plan?
What percentage of eligible employees would you expect to participate?
Investment Options
What types of investment vehicles would you like to offer eligible employees?
- Mutual Funds
- Self-Directed Brokerage Account
- Need more information to decide
Do you plan on matching any portion of the employee contribution?
- Yes
- No
Additional Information
Information Request
In our experience, we have found that there are several roadblocks — lack of goals, inappropriate investments, and procrastination — that keep most people from achieving financial success. Your ability to pursue your financial goals may depend on how well you are able to steer clear of these roadblocks.
Topic(s) of Interest
- Risk Management
- Cash Management
- Investment Planning
- Retirement Planning
- Estate Conservation
Describe your specific topic(s) of interest:
Any additional information to consider as we process your request?
Phone
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Contact Information

(507) 723-4811
(800) 772-8809
(507) 723-5950
101 N. Marshall Ave.
PO Box 205
Springfield, MN 56087
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