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Questionnaire

Term Life AND if YES check all that apply

Universal Life AND if YES check all that apply

Whole Life AND if YES check all that apply

Identify heirs such as siblings, children, grandchildren OR other beneficiaries...include name, approximate age, and relationship.

Do any of the following circumstances apply to your estate?

Identify real estate, financial accounts, personal property vehicles, collectibles, etc.

Identify all parties who may be considered lenders with unpaid balances such as banks, credit card companies, finance companies and all other third parties with outstanding loans subject to be repaid.

Include name, relationship, approximate age, and state of residence (key roles are trustee, personal representative/executor, legal guardian, power of attorney, and healthcare surrogate).

May include your personal goals and/or concerns OR description of ANY other matter pertaining to your unique circumstances.

*Submission of information to insuranceandestates.com, Steven Gibbs or Insurance & Estate Strategies, LLC does not establish an attorney-client relationship betwe with the user. We are acting as attorneys or agents and no representation can be presumed unless and until the terms of the agreement are confirmed in writing.

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Disclaimer: Life insurance policies are not investments and, accordingly, should not be purchased as an investment. In addition, by using this website, I confirm that I understand and agree to the applicable Privacy Policy and Terms of Service. I understand that by calling the phone number above I will reach a licensed sales agent. 14362 N. Frank Lloyd Wright Blvd, Suite 2151, Scottsdale AZ 85260. InsuranceandEstates.com is a free information source designed to help find insurance coverage. We compile our data from multiple sources, which includes the government, non-profit and private sources. The rates and information displayed are for informational purposes only and should not be construed as advice, consult, or recommendation. For specific plan details and further information, contact carriers directly.

Steven Gibbs is domiciled in Arizona. See the jurisdictions in which Steven Gibbs and our other agents are licensed, admitted or otherwise authorized to market insurance products and/or legal services to consumers. This website is provided by Steven Gibbs and Insurance and Estate Strategies LLC, an Arizona limited liability Company, in order to educate and inform the general public of the services we offer only. Due to Steven Gibbs active license as an attorney in Florida, this website may be interpreted to constitute attorney advertising. Submission of information to insuranceandestates.com or use of this website, does not constitute an attorney-client relationship with Steven Gibbs unless and until the terms of an attorney-client agreement are confirmed in writing.

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The following agent license numbers of Steven Gibbs are provided as required by state law: AZ agent #17508301, TX agent #2273189, CA agent #0K10610, LA agent #769583, MA agent #2049963, MN agent #40563357, UT agent #655544. Additional licenses of Steven Gibbs are available upon request. No portion of insuranceandestates.com may be copied, published, faxed, mailed or distributed in any manner for any purpose without prior written authorization of the owner. If an InsuranceandEstates visitor requests a quote, Insuranceandestates.com may enlist the help of other independent agents to help its customers find the best values. Life insurance policies described, quoted, shown and illustrated throughout this website are not available in all states. Rates and time taken to qualify and purchase a life insurance policy vary by product and underwriting requirements.

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