Have any questions?
(888) 677-6575
info@LEfinancialsolutions.com

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Get FREE insurance quotes and find your best price today.

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Insurance Type*

LIFE
Sex*
- Male
- Female
Birth Date*
Height*
Weight*
DISABILITY
Sex*
- Male
- Female
Birth Date*
Net Annual Income*
Have you ever used any tobacco or nicotine products?*
Our expert agents may be able to find low rates even if you're a current smoker or have recently quit.
- Yes
- No

LIFE
Do you currently have a life insurance policy?*
- Yes
- No
What is the amount of coverage of your current policy?
DISABILITY
Occupation*
Job Description*

LIFE
How much coverage would you like?*
Not sure? It's OK to estimate. If you'd like free advice, call us at 504.229.0708
Duration*
DISABILITY
Are you a business owner?*
- Yes
- No
Type of Business*
- LLC
- C-Corp
- S-Corp
Number of Employees*
Years in business*

LIFE
Have you ever used any tobacco or nicotine products?*
Our expert agents may be able to find low rates even if you're a current smoker or have recently quit.
- Yes
- No
Describe your cigarette usage*
Describe usage of other products*
DISABILITY
Is Group Long-Term Disability in force?*
- Yes
- No
Monthly Amount
Select
- 60%
- 67%

LIFE
Have you received any traffic violations, besides parking tickets, in the past five years?*
- Yes
- No
How many in the past 5 years?*
How many in the past 3 years?*
DISABILITY
Is Individual coverage in force?*
- Yes
- No
Monthly Amount
Is it to remain in force?
- Yes
- No

LIFE
Do you currently engage in any of the following sports or activities?*
- Piloting Aircraft
- Bungee Jumping
- Hang Gliding
- Mountain and Rock Climbing
- Scuba Diving
- Sky Diving
- Yes
- No
DISABILITY
Who will pay the premium?:*
- Employer
- Employee
Monthly Benefit*
Elimination Period*

LIFE
Have you been treated for any of these conditions? (check all that apply)*
Our expert agents may be able to find affordable rates even for people with less than perfect health.
- Alcohol or Substance Abuse
- Asthma
- Blood Pressure
- Cancer
- Cholesterol
- Depression or Anxiety
- Diabetes
- Heart Issue
- Sleep Apnea
- None of These
DISABILITY
Please select Benefit Riders
If you are unsure, leave blank.
- Residual
- COLA
- Non-Can
- Own Occ.
- Future Purchase Option
- Automatic Increase
- Return of Premium
- Activities of Daily Living
- Catastrophic Rider
- Social Insurance

LIFE
Did your parents and/or siblings, before they turned 65, have incidents of heart disease, cancer, stroke or diabetes?*
- Yes
- No
DISABILITY
Please list any medications currently used
A full medical history will be required.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Alternate Phone
Email*

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About us

For over 30 years, Leading Edge Financial Solutions has helped customers, just like you, explore financial options to plan for their future and that of their family.

Insurance needs, financial planning, and retirement can sometimes be a daunting process. Our team of dedicated professionals can help you to select the products that are right for your specific needs.

Secure Your Future Today

Find the right coverage for you and your loved ones.
Establish a contingency plan that will safeguard your future.
Explore the financial options that are most advantageous for your needs.
Commit to a plan and secure piece of mind for your family's future well-being.

Have any questions?

Speak directly with one of our experienced agents by calling (888) 677-6575 , or email us at info@LEfinancialsolutions.com.

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