Delta Financial Associates, Inc.

Long-Term Care ClickQuote Request

Step #1: Please tell us about yourself

Name:

Firm/Branch:

Phone:

E-mail:

Life & Health Licensed ? Yes No

Do you have your LTC CE? Yes No
(required in CA CO DE IL IN MD NC WA)

Sold LTC before? Yes No

Step #2: Think of a suitable client and suitability checklist.

Suitability checklist:

No obvious physical impairments (walker, quad cane, etc)

No mental impairments (memory loss, etc)

No planned or recent surgery

Mr.		Birth Date:
Mrs./Ms.		Birth Date:

Step #3: Ask us to design a proposed plan.

Monthly Benefit Amount: $
Minimum Benefit Period:	2 - 4 years 4 - 6 years 10 years Lifetime
Elimination Period:	20-30 days 60 days 90 days 180 days
Inflation Protection:	5% Compound 5% / 3% Compound 5% Simple None
Benefits:	Shared Benefit Cash Option Restoration of Benefits Return of Premium
Payment Options:	10-pay Lifetime
For Agent or Broker Use Only. Not To Be Used With The General Public. Please email by clicking on “Send a Copy” button above Or fax to: (732) 741-8752

Back | Questions? Ask Delta