Get a Life Insurance Quote

The Perimeter Group provides multiple ways to get an insurance quote. You can get an instant quote on-line to compare multiple carrier rates. Or, you can fill out our on-line quote form and submit it to us to have our staff look at an even greater number of carriers to get you the best rate available among our carrier roster. Finally, you can contact us via e-mail, phone or fax to start the quoting process.

In order to get the most accurate quote for insurance it is important to provide all of the information requested as accurately as possible. A good information resource is your current carrier insurance declaration pages that detail your coverage levels and other key information about your vehicles and properties.

Personal Information


Coverage Information

Coverage Type:
Level Term Life - How long do you want the premium and face amount to remain level?
Death Benefit (face amount) of requested coverage

Health Information

Date Of Birth
Height (feet & inches)
Weight (pounds)
Have you used tobacco in any form in the last 12 months?
Do you have any chronic health conditions?
Have you been hospitalized in the past 5 years?
Do you take any maintenance medications?
Has a previous life insurance application been refused or were you offered a policy at increased rates?

If you answered "Yes" to any of the questions above, please explain in the comments section below.


We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to provide you with a quote, and to release them from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.*