Quote Application Form

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Understanding Your Goals

What would you like to accomplish?*

Select all that apply to personalize your quote

Replace my Income

Pay off my mortgage

Cover my final expenses

Pay off my debt

Give me peace of mind

Rather Not Say

Who Do You Want To Protect?*

Select all that apply to tailor your coverage

Spouse

Children

Parents

Business Partner(s)

Charity

Other

When would you like your coverage to start?*

Today!

In a few weeks

I'm just shopping

You're on the right track.
Oros Life is here to help!

How We Work:

Understanding your goals

Tell us about yourself

See if you qualify

View your rate

What Is Your Gender?*

Male

Female

Do you use Tobacco or Nicotine?*

Yes

Which Nicotine Products Have You Used In The Past 12 Months?*

Rate Your Health*

This helps us give you the most accurate quote

Excellent

Good

Fair

Rate Your Health*

This helps us give you the most accurate quote

Excellent

Good

Fair

How Many Children Do You Have?*

This helps tailor your coverage

None

Total Debt and Mortgage?*

This helps when choosing the proper amount of coverage

$0 - $250,000

$250,001 - $500,000

$500,001 - $750,000

$750,001 - $1,000,000

$1,000,001 +

How much coverage do you need?*

Please enter a number greater than or equal to 100000.

Minimum $100,000

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How long do you need coverage?*

1 Year

10 Years

15 Years

20 Years

30 Years

Term life insurance would be a great solution to protect your...

Spouse

Children

Parents

Business Partner(s)

Charity

Other

How We Work:

Understanding your goals

Tell us about yourself

See if you qualify

View your rate

Are you a US citizen or a permanent resident?*

This helps us select the appropriate insurance carriers for your coverage

Yes

Call us, We may be able to qualify you for coverage!

(561) 319 - 6676

State of Residence*

For Pricing Accuracy

Your Date of Birth?*

Date cannot be in the future.

Your Name?*

Let's Personlize Your Quote

Last Name*

Verify your phone number *

Enter your phone number and we'll send a 6 digit code to confirm you're not a bot

Verify your phone number Enter your phone number and we'll send a 6 digit code to confirm you're not a bot*

By entering your mobile number and clicking "Let's Get You Verified", you agree to receive a one-time SMS verification code from OROS LIFE INSURANCE for identity verification. Message and data rates may apply. Reply STOP to opt-out.

Verification code*

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This phone was already verified when you first requested a quote, so there's no need to verify it again. You can go ahead and click 'Next'.

Your Email?*

We will send you a copy of your customized quote

Here’s Your Personalized Life Insurance Quote

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Coverage
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Term
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Monthly

Most clients get covered with no medical exam

Please contact us for an estimate

More Policy Options

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Alternative Estimate

Coverage Amount:

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Monthly Cost:

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For How Long:

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Please contact us for an estimate

View Plan Details

Annual renewable term policies automatically renews each year with slightly increased premiums until age 80 depending on the carrier.

Adjusted Estimate

Coverage Amount:

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Monthly Cost:

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For How Long:

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Adjust Estimate

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Adjust My Estimate

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Coverage Amount

Please enter a number greater than or equal to 100000.

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How long would you like to have coverage?

Please Select years of coverage

Update My Estimate

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Select Type

Continue with application

Schedule call

Thank you for Choosing Oros Life! Please give us a call at (561) 319-6676 or select a date and time that works best for you.

Your Oros Life Policy Awaits – Just 5 Minutes to Apply!

Our quick and secure application process makes protecting your loved ones simple.

🛡️

Congratulations on getting your free quote with Oros Life! You're moments away from securing coverage tailored to you. Here's what's next:

❓

Quick Questions

Answer a few questions about your health and lifestyle.

🔒

Secure Process

Your information is protected with state-of-the-art encryption.

⚡

Fast Confirmation

We'll review your application and follow up within 24 hours.

Most customers breeze through in under 5 minutes. Let's get started!

Why Choose Oros Life?

🔒

100% Secure

Your data is safe with our advanced encryption.

⏱️

5 Minutes or Less

Join thousands who've applied quickly.

❤️

Trusted by Families

Oros Life is here for you, every step of the way.

Need Help?

Not ready to apply? Call us at (561) 319-6676 or schedule a chat with a friendly Oros Life agent.

Questions? Visit our FAQ for answers.

At Oros Life, your family's future is our priority.
Reach out at info@oroslife.com or (561) 319-6676.

Appointment Date*

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Appointment Time*

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Appointment*