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JUST SUPPOSE YOU WERE THE ONE (1) OUT OF (3) AMERICANS WHO WOULD *LOSE *YOUR INCOME OR / *YOUR ABILITY TO WORK DUE TO CANCER OR A CATASTROPHIC ACCIDENT...
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* Indicates required question
(A.) Your bank would want to know how would you *IMMEDIATELY SURVIVE financially?
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Savings
Loans
Liquidated Assets
Required
(B.) Which one of these unpaid debts would concern you most?
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Rent
Groceries
Mortages
Utilites
Car Note
Taxes
Required
By Referral Only, *What Our Company Has Is Not For Everybody, And It *May *Not Be For You...
By The Way, *Please Tell Us Which One Of Your Banks Do You Bank With?
(Even If Your Bank Isn't On Here, Please Continue To See If You Qualify...)
Your answer
(C.) If you QUALIFIED for a plan that would offset your debts in the event of a *CRITICAL ILLNESS SUCH AS *CANCER, HEART ATTACK, DIABETES, STROKE OR A *CATASTROPHIC ACCIDENT.... WOULD YOU TAKE ADVANTAGE OF IT?
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Yes
No
In The Event Of A *Catastrophic Accident Or *Critical Illness, To Offset *Tremendous Out Of Pocket Expense, *Who's Checkbook Would You Prefer Using, Yours or Ours?
Yours
*Ours
Clear selection
In The Event Of *Catastrophic Accident or *Critical Illness, Which Would You Prefer?
Get Well Card
*Check
Clear selection
(D.) Just suppose your bank and our company provided you with a benefit plan that LITERALLY *PAID YOU TO *STAY HEALTHY, AT VIRTUALLY NO COST TO YOU, PROVIDED THAT YOU MEET THE QUALIFICATIONS, WOULD YOU CONSIDER LOOKING AT IT?
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Yes
No
To See If You *Qualify, Please Complete The Following:
Smoker / Non Smoker ?
Smoker / Non Smoker ?
Smoker of cigarettes in past 12 months
Medicinal Use of Marijuana in past 12 months
Recreational Use of Marijuana in past 12 months
Clear selection
Name
*
Your answer
Address
Your answer
Date of Birth
MM
/
DD
/
YYYY
Phone number
*
Your answer
Email
*
Your answer
*Life Writes The Checks, and *Time Makes No Appointments.
Our *Mission Is To Transfer The *Risk, From *Your Checkbook To *Our Checkbook, To Free *You From *Your Concerns!
Thank you for participating in our survey
CAPITOL INSURANCE GROUP The money-back people.
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