Lead Type: Disability Insurance
Date Received: 01/10/2006

Contact Infomation:

Name:Elizabeth Peterson
Address: 1306 Rotterdam Place
City: Fort Collins
State: CO
Zip: 80526
Primary Phone: (970) 226-4658
Alternate Phone: (877) 847-4658
Email:liz.peterson@hotmail.com

Insured Information:

Sex: Female
Age: 50
Height/Weight: 5'6" 135 pounds
Tobacco: No
Currently pregnant or will be pregnant wihtin 10 months? No
Currently disabled? No
Self Employed:No
Occupation: toxicologist
Salary: 65000
Number of Years at Job: 10

Policy Information:

Do you currently have Disability Insurance: No
Duration of Coverage needed: 2 years
Amount of Coverage needed: 60% of my income
Date Coverage needed: ASAP

Health Conditions, Medications, and Other Information:

successfully treated for breast cancer in 1995. No recurrance.

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