Quote Application Form

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Protecting What Matters

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

I'm Not Sure Yet 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 Loved Ones 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 Year

15 Year

20 Year

30 Year

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 Personalize 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 SMS messages from OROS LIFE INSURANCE, including a verification code and future updates about your insurance application. Message and data rates may apply. Reply STOP to opt out at any time.

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

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Select Type

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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.

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Appointment Time*

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Quote Application Form

Here’s Your Personalized Life Insurance Quote

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