Louisiana Life Insurance |Free Quote from Landeche Insurance, LLC

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INFORMATION ABOUT OUR INSURANCE PLANS
LIFE INSURANCE - INDIVIDUAL HEALTH INSURANCE - GROUP HEALTH INSURANCE - LONG TERM CARE - ANNUITIES
MEDICARE SUPPLEMENTAL INSURANCE - GAP SUPPLEMENTAL INSURANCE

REQUEST A FREE INSURANCE QUOTE
Individual Health Insurance - Group Health Insurance - Life Insurance - GAP Supplemental Insurance - Medicare Supplemental Insurance - Annuities
We also offer: Dental Insurance, Vision Insurance, Short Term Medical Insurance and Overseas Travel Insurance

Free Life Insurance Quotation
Please complete this one page
Life Insurance Quotation Request Form


	Name


	Address


	City

State

Louisiana


	Zip Code


	E-Mail Address


	Phone Number


	Date of Birth


	Do You Use Tobacco In Any Form?


	Yes


	No


	If Yes, What Form?


	If Yes, Usage Amount


	Your Height


	feet


	inches


	Your Weight


	pounds

Is pressure reading
145/85 or less?


	Yes


	No


	Cholesteral Reading

Have you, either parent, brothers or sisters been diagnosed with or died from cardiovascular disease prior to age 60?


	Yes


	No

Have you, either parent, brothers or sisters been diagnosed with or died from cancer prior to age 60?


	Yes


	No


	Motor Vehicle Record

Have you had 2 or more violations in the last 3 years?


	Yes


	No

Any DUIs, reckless driving or suspensions?


	Yes


	No


	Any hazardous vocations?


	Yes


	No


	Are you a pilot?


	Yes


	No


	Any alcohol or substance abuse?


	Yes


	No


	Amount of Coverage


	Type of Coverage Desired


	How would you like to receive your Life Insurance Coverage Quotation?


	By phone


	By e-mail


	By fax


	If by Fax, Enter Fax Number


	Comments or Questions


	CLICK HERE >>>

Landeche Insurance, LLC
2000 Neely Street; Jefferson, LA 70121

Phone: 504-228-7184
Fax: 504-252-9923
We are here to help!

E-mail: info@landecheinsurance.com

Landeche Insurance, LLC provides individual health insurance, group health insurance, life insurance, dental insurance, vision insurance, GAP supplemental insurance, Medicare Supplemental Insurance and annuities to New Orleans, Metairie, Kenner, Harahan, Jefferson Parish and all surrounding areas in Louisiana.

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