Any private information required to obtain a life insurance policy will ultimately require your signature. This form will be sent to you via mail.

This form and signature will allow the insurance company to underwrite the policy.

We are committed to keeping all personal information related to your insurance applicaton private, PERIOD!

LEGAL

These quotes are an example from the life insurance company selected. Not all policies available in all states. Rates can differ from these based on age, sex, and medical history.

Currently , AFFORDABLE LIFE, operates under the DBA of agent Eric Van Haaften. Eric Van Haaften is licensed in the following states: FL, GA, IA, IL, IN, KY, MA, NC, OH, PA, VA, and WV.

RATE DISCLAIMER

Premiums illustrated represent 10 year level term insurance with guaranteed level premiums for 10 years (not all forms available in all states). $100,000 rates are LTG Ultra-C 10 [policy form no. LTG-C01AG Preferred Non-tobacco]. $250,000 - $1,000,000 rates are LTG Ultra 10 Select Class II [Select Class II policy form no. LTG-2000AG Non-tobacco]. It is issued by American General Life Insurance Company, Houston, TX. Medical examination required. Premiums increase at the end of the guaranteed term if policy is renewed. Premiums for other rate classes, age and payment plans are available upon request. Death benefit remains level and is payable in lump sum, or installments, if so elected. The insurance company may contest the policy for two years from date of policy issue for material mis-statements or omissions on the application. Death benefit payable from any cause, except suicide within first two policy years. In the event of suicide in the first two years, policy benefit is limited to return of premium paid. NOT AVAILABLE IN ALL STATES. American General Life Insurance Company is a member of the American International Group, Inc. The underwriting risks, financial obligations and support functions associated with the products issued by American General Life Insurance Company are solely its responsibility. American General Life is responsible for its own individual financial condition and contractual obligations.