Contact Infomation:
  Name: Dan Johnstone
  Address: 1935 Ruckers Drive
  City: Decatur
  State: GA
  Zip: 30033
  Primary Phone: (404) 292-0385 Day,Evening
  Alternate Phone: (678) 401-2934 Day,Evening
  Email: djohnstone71@comcast.com

Insured Information:
             Sex      dob       Height  Weight
          ------- ---------- --------- ---------
  Primary: Male   05/28/1968    6'1"    190
  Spouse:  Female 07/22/1970    5'7"    125
  Child 1: Male   09/02/1992
  Child 2: Male   11/15/1996
  Child 3: Female 10/06/1998
  Child 4:

Insureds that currently use tobacco: None
  Currently Insured: No
  If insured, carrier name:
  Self Employed: No
  Occupation: Engineer

Policy Information:
  Full Time Student: No
  Duration of Coverage needed: Greater than 6 months
  Diabetes: No
  Date Coverage needed: 1/1/2009

Health Conditions, Medications, and Other Information:

  Is anyone to be covered currently pregnant? No

Other Health Conditions and Information:

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