Lead Type: Key Person Life Insurance
Date Received: 01/06/2006

Contact Information:
Business Name: Hermar LLC
Contact Name: Marion Evans
Address: 2160 N Milwaukee
City: Chicago
State: IL
Zip: 60618
Phone Number: (773) 481-1040
Fax: (773) 481-1144
Email: evansmar4165@yahoo.com

Business Information:
Industry: Accountants/Bookkeepers
Nature of business:
Number of key persons: 2

Insurance and Underwriting Information:
Currently insured for Key Man Life?: no
Do you need buy-sell paperwork:
Do you want coverage for disability:

Other info your Agent needs to know:

Key Person Number 1:
Role:
Sex: F
Birthday: 01/25/1944 or age:
Height: 5'6"
Weight: 180
Tobacco: Never
Health Problems: ,
Quote #1: Amount: $1,000,000 Type: Not Sure
Quote #2: Amount: $1,500,000 Type: Not Sure

Key Person Number 2:
Role:
Sex: F
Birthday: 06/06/1950 or age:
Height: 5'0"
Weight: 190
Tobacco: Never
Health Problems: ,
Quote #1: Amount: $1,000,000 Type: Not Sure
Quote #2: Amount: $1,500,000 Type: Not Sure

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