Protecting Families With Burial or Funeral Insurance

No Medical Exam —

Simple Application

Free Quote—Apply Online

Gender *

Male

Female

Date of birth *

What state do you live in? *

What state do you live in?

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Who is your Beneficiary *

Are you a smoker or non-smoker? *

I am a smoker

I am a non-smoker

Any history of cancer, heart disease, stroke? *

Yes

Do you currently have any life insurance? *

Yes I do

No I do not

How much burial life insurance do you think you will need to protect your loved ones? *

Less than $10,000

$10,000 - $20,000

$20,000 or more

What is your First Name? *

What is your best email address? *

What is your mobile number? (To confirm your questionnaire info and provide your custom plan) *

Terms and Conditions for American Senior Benefits Plan
By clicking through the survey you consent to have Chris from American Senior Benefits Plan contact you via email, phone and or text.

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only where licensed and appointed. is licensed to sell insurance products in the following states:

licensing information can be found here.