Recent News

March 18, 2011
ISC Welcomes Karen VanDenBusch

Karen will be Specializing in Senior Insurance Products.

Karen brings over 25 years of education and experience in the... More

September 30, 2010
ISC Welcomes Julie VanBoxtel

ISC is pleased to welcome Julie VanBoxtel to our sales team. Julie brings several years of insurance experience along with... More

Disability Insurance Quote

Insured Information

Insured Name: *
Address:
City:
State:
Zip:
Home Phone:
Email: *
Use Tobacco:
Gender:
Height:
Weight:

Insured Medical Information

Describe any pre-existing Health conditions:
List any medication, including dosage and frequency
Note any other pertinent information or requests for coverage

Disability Insurance Information

Occupation:
Duties:
Earning:
Earning Frequency:
Other Disability Coverage:
Other Disability Coverage Type:

Disability Benefits to be Quoted

Elimination Period STD:
Percentage Payable STD:
Maximum Monthly Benefit STD:
Duration of Benefits STD:

Elimination Period LTD:
Percentage Payable LTD:
Maximum Monthly Benefit LTD:
Duration of Benefits LTD:

* Indicates a required field

Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.