LTC-INFO.COM: Request LTC Answer Guide

Please Note: If you are an Insurance Agent or Other Professional seeking a quote for a Client or someone else, please send your request for a Quote by Clicking Here INSTEAD of filling out the script. THANKS!

How Does This Work?

By filling out this form, you will receive a FREE Long Term Care Insurance Answer Guide. You will be given the option to receive it by US MAIL which takes 4 to 8 weeks or to receive it immediately via ELECTRONIC DOCUMENT (web page).

This process is broken into 4 easy steps

Give us your contact and other related information
Give us some information about the person for whom you are making this inquiry
Go over each of your entries to make sure that it is entered correctly
Once you click SUBMIT, Just sit back and relax!
We'll do all the work from that point to get you the info that you want!

Please note: After we receive your request, we will send you detailed information via email -- it is very important that you provide a valid and working email address otherwise you will not receive our detailed reply message(s).

PRIVACY POLICY:
All communications from us will be related to your request for information about Long-Term Care Insurance.
We will never sell or otherwise disclose your email address, personal information or contact information to anyone for any other purpose.
You will not receive unsolicited emails or advertisements.
Unlike many websites, we do not collect data about you or your inquiry other than what you willingly provide.

We value your privacy and trust as we value our own.

Lets Begin!
(* indicates required fields)

First, we need some information about YOU
(the person who is filling out this form)

*What is YOUR Salutation:

[Mr. ] [Mrs. ] [Ms. ] [Miss. ]

*What is YOUR First & Last Name:

*What is your Email Address:

This is important - we need this in case we have a question
& are unable to process your request.
We *NEVER* sell or share email addresses with anyone.
(AOL Members: Please enter your WHOLE email address
Simply, add "@aol.com" to your screenname
Example: chuck2341 = chuck2341@aol.com)
If you don't have an EMAIL ADDRESS, please Click Here

*What is your DAY Phone Number:

(Please include your AREA CODE
failure to provide a valid phone number or
entering bogus data will cause your request to be deleted)

*What is your EVENING Phone Number:
(Please include your AREA CODE)

At least once a day, we send an email message that BOUNCES (cannot be delivered) because of an mis-typed/incorrect email address. PLEASE double check your email address and phone number now and type YES once you've confirmed that they are entered correctly.

Have you entered your email address and phone numbers correctly?

**THIS IS A VERY IMPORTANT QUESTION**

*Who are you looking into this for:
(Who is this INFO for?)

Other (from previous question):
(you may also use this field for a brief comment if you wish)

*How did you hear about this LTC Insurance Info Page?:
(please be specific, it helps us to know this information)

**IMPORTANT**

Now we need some information about the person(s)
for whom you are requesting this INFO.

If you are requesting it for YOURSELF,
just answer the questions with YOUR OWN information...

If you are requesting this information for SOMEONE ELSE,
then answer these questions with THEIR information!

Please note: rates vary by state, so it is important that we know the address of the person for whom the info is needed.

*What is YOUR/THEIR Salutation:

[Mr. ] [Mrs. ] [Ms. ] [Miss. ]

If you are requesting this information for YOURSELF, then please RE-TYPE your name as you typed it above...

*What is YOUR/THEIR First & Last Name:

*What is YOUR/THEIR Spouse's Name:
(enter "n/a" or "not applicable" if no spouse exists)

Once again, if you are requesting this information for YOURSELF
then provide YOUR information...

but if you are requesting this information for SOMEONE ELSE,
then answer these questions with THEIR information!

*What is YOUR/THEIR Street Address:
(line 1)

*What is YOUR/THEIR Street Address:
(line 2)

*What is YOUR/THEIR City:

*What is YOUR/THEIR State:
(Please select 2 letter abbrev. for your state)

*What is YOUR/THEIR Zipcode:
(Please supply the nine-digit zip if you know it)

Now we need some birthdates...(optional)

What is YOUR/THEIR Birthday
(NOTE: You can select "00" for DAY if you don't want to disclose actual birthdate):

Month	Day	Year

What is YOUR/THEIR Spouse's Birthday
(NOTE: You can select "00" for DAY if you don't want to disclose actual birthdate):

Month	Day	Year

Two more questions and we are done!

*Have YOU/THEY already APPLIED for an LTC Insurance Plan
(or do they already have a policy)?:

[Yes ] [No ]

*Do YOU/THEY plan to PURCHASE LTC Insurance in the next 30-90 days?:

[Yes ] [No ]

OK, now the last step...
Go back over your answers
When you are done just press SUBMIT!

Legal Disclosure: If you are an insurance agent
or are involved in selling Long Term Care Insurance in any way,
you must CLICK HERE to submit your request.
Please do NOT submit your request using this form.

(** By pressing SUBMIT, you understand that you will be contacted to gather the additional information that we will need. Please click SUBMIT only *once* -- the system may take a few seconds to respond **)

[All information will be kept confidential & will NOT be sold or shared with anyone else]

Only residents of the U.S. are eligible to receive this information ...

If you found this website to be useful, please BOOKMARK IT for future use!
If you would like to RECOMMEND THIS SITE to a friend just CLICK HERE.

For answers to your specific questions, call 303-663-5690 or email us.

Get A Quote

doug@ltc-info.com

Free LTC Guide

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