Keltner Insurance Inc
Your Local Independent Insurance Agency
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Short Life Quote
For Help Call 901-797-8665
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Name
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Date of Birth
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Address
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Contact Phone
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Email
Any preexisting medical conditions
Tobacco user (including chewing tobacco)
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Cigarette Usage
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Never Smoked or Quit Smoking 10 years ago
Quit Smoking 5 years ago
Quit Smoking 2 years ago
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Policy Term
10 Year
20 Year
30 Year
Whole Life
Amount of Coverage
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up to $100,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$500,000
$750,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
$4,000,000
$5,000,000
over $5,000,000