Individual Disability Lead

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Lead Number: 5007350
Lead Type: Disability Insurance
Date Received: 02/03/2005

Contact Infomation:
Name:Kenneth DeLuca
Address: 4180 Towne Park dr
City: Mcdonough
State: GA
Zip: 30253
Primary Phone: (770) 584-4200
Alternate Phone: (770) 447-6477
Email:kglendeluca@aol.com

Insured Information:
Sex: Male
Age: 53
Height/Weight: 5'11" 195 pounds
Tobacco: Never
Currently pregnant or will be pregnant wihtin 10 months? No
Currently disabled? No
Self Employed:No
Occupation: Sales Inside
Salary: 70,000
Number of Years at Job: 7

Policy Information:
Do you currently have Disability Insurance: No
Duration of Coverage needed: To age 65
Amount of Coverage needed: 60% of my income
Date Coverage needed: Soon

Health Conditions, Medications, and Other Information:

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