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Tobacco Use:		I smoke more than one pack per day. I smoke no more than one pack per day. I am on "The Patch." I chew nicotine gum. I used to smoke, but quit less than 1 year ago. I used to smoke, but quit 1-2 years ago. I used to smoke, but quit 2-3 years ago. I used to smoke, but quit 3-5 years ago. I used to smoke, but quit over 5 years ago. I have never smoked. I smoke cigars. I smoke a pipe. I chew tobacco.
Coverage Type:		Type... 30-Year Guaranteed Level Term 25-Year Guaranteed Level Term 20-Year Guaranteed Level Term 15-Year Guaranteed Level Term 10-Year Guaranteed Level Term Universal Life Select
Birthdate:		Month January February March April May June July August September October November December  /  Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  /  Year 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929
Coverage Amt:		$50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 $450,000 $500,000 $550,000 $600,000 $650,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 $1,000,000 $1,250,000 $1,500,000 $1,750,000 $2,000,000 $2,250,000 $2,500,000 $2,750,000 $3,000,000 $3,250,000 $3,500,000 $3,750,000 $4,000,000 $4,250,000 $4,500,000 $4,750,000 $5,000,000 $5,500,000 $6,000,000 $6,500,000 $7,000,000 $7,500,000 $8,000,000 $8,500,000 $9,000,000 $9,500,000 $10,000,000 OVER $10,000,000 How much do I need?
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