Life Insurance Survey
Sex
Male
Female
Do you smoke?
No
Yes
Do you have Life Insurance?
Yes
No
Do you need Life Insurance?
Yes
No
How much Life Insurance do you need?
$250,000
$500,000
$1,000,000
Other
If you could purchase $250,000 for less than $50/month, would you buy it now?
Yes
No
When would you be in a position to purchase life insurance?
30 days
3 months
6 months
1 year
Other
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