Life Rejection Form |

Agent Name

First Last

Reference ID:

Name*

First Last

Email*

Phone

Do you accept or reject life insurance protection?

Reject
Accept
More Information Desired

I was offered life insurance protection through the Kim Hastings Agency, and reject this coverage because:*

Already Have Coverage in Place
No Insurance Needed
I Am Not Insurable

Accept or More Information Desired*

Please contact me about this discount.
I would like to set up an appointment to discuss.
Email me the information.
Where can I research on my own?

To schedule an appointment, go to: https://contractcoach.myclients.io/site/theinsuranceteacher/online-scheduling.

When you submit this form, an email with this link will be sent to your in box.

To get more information, please create an account on our website (https://theinsuranceteacher.com).
Once you submit this form, instructions will be sent to you provided email. If you don't see it, please check your SPAM and add theinsuranceteacher.com to your safe senders list.

Signature Required:*

Life Rejection Form

Life Insurance Rejection Form