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Height
3 Feet
4 Feet
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6 Feet
Height Inches *
Inches
0 Inches
1 Inches
2 Inches
3 Inches
4 Inches
5 Inches
6 Inches
7 Inches
8 Inches
9 Inches
10 Inches
11 Inches
Weight *
LBS
Weight
100
105
110
115
120
125
130
135
140
145
150
155
160
165
170
175
180
185
190
195
200
205
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215
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225
230
235
240
245
250
Birth Date*
MM
01
02
03
04
05
06
07
08
09
10
11
12
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YY
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
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Do you have any medical conditions?
Yes
No
Gender
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Tobacco Use
No
Yes
Are you active or retired military personnel?
Yes
No
Type of Insurance You Are Considering?
Preferred Plus
Preferred
Standard
Amount of Coverage
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$950,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,250,000
$3,500,000
$3,750,000
$4,000,000
$4,250,000
$4,500,000
$4,750,000
$5,000,000
$5,500,000
$6,000,000
$6,500,000
$7,000,000
$7,500,000
$8,000,000
$8,500,000
$9,000,000
$9,500,000
$10,000,000
$99,999,000
$50,000
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