Washington Long Term Care Insurance Quote

Washington Long Term

Care Insurance Quote

We can provide lower cost Washington Long Term Care Insurance

coverages in Spokane County, WA and throughout the Evergreen State!

The Fletcher Agency of
Spokane, WA offers
affordable and
experienced personal
insurance coverage
services throughout
Washington.

Contact us about
Washington Auto,
Renters, Homeowners,
Boat, Motorcycle,
Earthquake, Flood, and
Condominium Insurance
at (509) 324-6311.

In addition to
Washington Long Term
Care Insurance quotes,
we also offer affordable
Term Life Insurance
policy quotes.

We are a Spokane, WA insurance agency offering affordable
Washington long term care insurance quotes in the following
towns, cities and counties in Washington state: Opportunity,
Millwood, Dishman, Seven Mile, Veradale, Spokane Valley,
Trentwood, Pasadena Park, Glenrose, Country Homes,
Greenacres, Newman Lake, Otis Orchards, Airway Heights,
Mead, Colbert, Buckeye, Chattaroy, Milan, Deer Park, Elk, Clayton,
Tumtum, Long Lake, Ford, Deep Creek, Reardan, Four Lakes,
Medical Lake, Espanola, Marshall, Tyler, Cheney, Vallyford,
Spangle, Plaza, Mica, Freeman, Manito, Fairfield, Waverly,
Rockford, Whitman County, Pend Oreille County, Lincoln County,
Stevens County, and Spokane County, WA. We can also offer
lower cost Washington long term care insurance policy quotes
throughout the state of Washington.

Full Name:
Mailing Address:
City:
State: Washington or Idaho
Zip Code:
Email Address: (Required)
Home Phone: Work Phone: Ext.
How to Contact You:       Cell Phone:
Date of Birth:             (mm/dd/yyyy)
Gender:    Height: ft.
Weight:    Do you smoke?
Do you currently have long term care insurance?
Current Premium:$ per month

Washington Long Term Care Insurance Coverage Information:

Coverage requested for?
Daily Benefit Amount: $
Benefit Period:
Elimination Period:
Payment Mode:

Asset Information:
Do you own or rent your primary residence?
What amount do your current assets total?

Medical Information:
Are you currently taking or have you taken any prescription or over-the-counter
medications during the last 12 months?

If you answered "Yes" to the question above please
provide the necessary information below:

Medication Name:    Dosage:
Frequency:    Condition:

Medication Name: Dosage:
Frequency:    Condition:

Medication Name: Dosage:
Frequency:    Condition:

Is Spouse to be insured?
Spouse: Full Name:
Spouse Date of Birth: (mm/dd/yyyy)
Spouse Gender: Spouse Height: ft.
Spouse Weight:
Does your Spouse smoke?
Is Spouse married to Applicant?

Is Spouse currently taking or has taken any prescription or over-the-counter
medications during the last 12 months?

If the answer was "Yes" to the question above please
provide the necessary information below:

Medication Name: Dosage:
Frequency:    Condition:

Medication Name: Dosage:
Frequency:    Condition:

Medication Name: Dosage:
Frequency:    Condition:

Additional Comments or Requests

Click on the "Submit Insurance Quote Request" button below to send
your Washington Long Term Care Insurance quote request.**

**Information received from this Washington Long Term Care Insurance quote request form sent to The Fletcher Agency will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the Washington long term care insurance policy information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle you to a Washington Long Term Care Insurance policy. We are licensed in Washington and Idaho, and will not provide long term care insurance quotes for other states.