Please fill out this form and we will get back to you at our earliest convenience.

What do I need





SECTION I: GENERAL INFORMATION
Are you single or married?
Are you single or married?
What is your name?

Your Name

Your Spouse’s Name
What is your email?

Your Email

Your Spouse’s Email
What is your phone number?

Your Phone Number

Your Spouse’s Phone Number
How old are you?

Your Age

Your Spouse’s Age
Do you have kids?
Do you have kids?
How many kids do you have?


How old are your kids?


What do you do for work?

Your Work Occupation

Your Spouse’s Work Occupation
For how long have you worked?

Your Years of Work

Your Spouse’s Years of Work
SECTION II: HOW CAN WE HELP YOU
What are the biggest concerns that I can help you solve today?

SECTION III: YOUR GOALS
What are your main short-term goals both personal and career wise?

What are your main long-term goals both personal and career wise?

For retirement, we believe in providing our clients a lifetime income that they will not outlive. How much income do you need for retirement monthly?

At what age would you like to start your retirement?

What are your retirement plans? Where are we going? Paint me a picture.

SECTION IV: BEST LIFE INSURANCE HOUSTON CAN HELP YOU!
We want to provide you peace with a plan in place, security with a lifetime income and freedom to live the life you desire.
If we can provide these three things within your budget, can we start today?
We want to provide you peace with a plan in place, security with a lifetime income and freedom to live the life you desire.
If we can provide these three things within your budget, can we start today?
SECTION V: FINANCIAL OVERVIEW
How much life insurance do you currently have in place?

Life Insurance
If you become ill, do you have a plan that will help you financially?

Living Benefits
What are you currently doing for retirement? (401K, IRA) Do you have a company match?

Current Retirement
Do you have savings plan?

Saving Plan
Do you have pre-planned funeral arrangements?

Pre-planned funeral arrangements
Do you have a will or trust?

Will or trust
Debt – How much do you owe on auto loans, student loans, credit cards, or personal loans?

Sum of Your Debts

Sum of Your Spouse’s Debts
Income – What is your yearly income?

Sum of Your Income

Sum of Your Spouse’s Income
Mortgage – How much do you owe on your home?

Mortgage (if applicable)
Education – For education, they recommend 20K per year, per child for college

(20k x 4 years = 80k per child for college) Multiply the number of kids x 80k = amount needed
Your Protection Needed

Add everything together and you will have the protection needed.


Add everything together and you will have the protection needed.


SECTION VI: PERSONAL PLAN

We are going to contact you with a personalized personal plan for you and your family.

Not sure where to start? Fill out our unique form and we will find the best life insurance for you.