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List: aix-l
Subject: Are You paying Too Much FOR Life Insurance?
From: termlife4598 () eudoramail ! com
Date: 2002-03-29 0:55:36
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<HTML><FORM action="mailto:lIIIlllIIlllllll@excite.com?subject= Insurance Quote Request" method=POST encType=text/plain><BODY text=#333333 vLink=#666666 aLink=#ff9900 link=#333333 bgColor=#ffffff><TABLE cellSpacing=0 cellPadding=0 width=600 align=center border=0><TBODY><TR><TD><P style="MARGIN-BOTTOM: -3px"><IMG src=http://us.f1.yahoofs.com/users/1e1000e9/bc/friends/__hr_head2.jpg?bcQjy88Aw21hXlDN border=0></P></TD></TR><TR><TD bgColor=#C0C0C0><DIV align=center><B><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2><font face=Arial size=2>Representing the top 200 Life Insurance Carriers<br> </font></FONT></B><FONT face="Verdana, Arial, Helvetica, sans-serif"><B><BR><FONT color=#4b4b4b size=2>Since 1996, term life insurance rates have been reduced by as much as 70%</FONT><BR><FONT color=#ffffff size=2>40 year old male - $250,000 - 10 year level term</FONT></B></FONT></DIV><DIV align=center><B><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>As low as $11.00 per month!<br></FONT></B></DIV><DIV align=center> </DIV><DIV align=center> </DIV><TABLE cellSpacing=0 cellPadding=1 width=500 align=center border=0><TBODY><TR><TD><P style="MARGIN-TOP: -5px; MARGIN-LEFT: 15px; MARGIN-RIGHT: 10px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>At<B> TermQuotes Life Insurance Companies of America, </B>we will survey the top life insurance companies for you and provide you with the best rates available.</FONT><P style="MARGIN-LEFT: 15px; MARGIN-RIGHT: 10px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>The quote is FREE. There is no obligation to buy. Compare the rates and see for yourself. Fill out this quick form below for further information.</FONT></P></TD><TD><IMG src=http://us.f1.yahoofs.com/users/1e1000e9/bc/friends/happy+family.jpg?bcQjy88AHJwq64ez border=0></TD></TR><TR bgcolor=#C0C0C0><TD colSpan=2><P style="MARGIN-BOTTOM: 10px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2> Results of computer survey: <font color=#CC3333>01-02-02</font></FONT><FONT face="Arial, Helvetica, sans-serif" color=#000000 size=2><BR> </FONT><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2> Sample Annual Premiums</FONT><FONT face="Arial, Helvetica, sans-serif" color=#000000 size=2><BR> </FONT><B><font face="Verdana, Arial, Helvetica, sans-serif" color=#CC3333 size=2> " 10 Year Level Premium Term Rates "</font></B></P><DIV align=center><CENTER><TABLE cellSpacing=1 width=400 border=0><TBODY><TR bgcolor=#000000><TD align=middle width=100><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px" align=center><b><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>Age</font></b></P></TD><TD align=middle width=100><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><b><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$250,000</font></b></P></TD><TD align=middle width=100><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><b><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$500,000</font></b></P></TD><TD align=middle width=100><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><b><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$1,000,000</font></b></P></TD></TR><TR><TD align=middle width=100 bgColor=#3974AE><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>35</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$115</font></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>$180</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$300</font></P></TD></TR><TR><TD align=middle width=100 bgColor=#3974AE><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>45</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$210</font></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>$370</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$640</font></P></TD></TR><TR><TD align=middle width=100 bgColor=#3974AE><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>55</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$475</font></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>$880</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$1,690</font></P></TD></TR><TR><TD align=middle width=100 bgColor=#3974AE><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>65</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$1,248</font></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>$2,425</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$4,700</font></P></TD></TR><TR><TD align=middle width=100 bgColor=#3974AE><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>70</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$1,898</font></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2>$3,725</FONT></P></TD><TD align=middle width=100 bgColor=#6699CC><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><font face="Verdana, Arial, Helvetica, sans-serif" color=#FFFFFF size=2>$7,380</font></P></TD></TR></TBODY></TABLE></CENTER></DIV><P style="MARGIN-TOP: 4px; MARGIN-LEFT: 50px; MARGIN-RIGHT: 50px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" size=1>*Above rates guaranteed to remain level for 10 years.</FONT></P><P style="MARGIN-TOP: -20px; MARGIN-LEFT: 50px; MARGIN-RIGHT: 50px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" size=1>Rates based on male preferred class 1 non-smoker.</FONT></P><P style="MARGIN-TOP: -20px; MARGIN-LEFT: 50px; MARGIN-RIGHT: 50px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" size=1>Policies are guaranteed renewable to age 95.</FONT></P><P style="MARGIN-TOP: -20px; MARGIN-LEFT: 50px; MARGIN-RIGHT: 50px" align=center><FONT face="Verdana, Arial, Helvetica, sans-serif" size=1>Policies with 15, 20, 25 and 30 year level premiums also available.</FONT></P><P style="MARGIN-TOP: -20px; MARGIN-LEFT: 50px; MARGIN-RIGHT: 50px" align=center> </P><P align=center><B><FONT face="Arial, Helvetica, sans-serif" color=#666666 size=4>Attention All Smokers,<BR>you may qualify for special reduced smoker rates!</FONT></B></P><P style="MARGIN-BOTTOM: 5px" align=center><FONT face=Arial size=2>Universal Life, Second-to-Die and Estate Planning products also provided.</FONT></P></TD></TR><TR><TD colSpan=2><DIV align=center><CENTER><TABLE height=285 cellSpacing=0 cellPadding=2 width=500 border=0><TBODY><TR bgcolor=#000000><TD vAlign=top colSpan=2 height=40><P style="MARGIN-TOP: 10px; MARGIN-LEFT: 5px" align=left><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#ffffff size=2><B>Submit This Form for a FREE Term Insurance Quote!</B></FONT></P></TD></TR><TR><TD align=left width=232 bgColor=#3974AE><P style="MARGIN-LEFT: 5px"><B><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Name Insured</FONT>:</B></P></TD><TD align=left width=260 bgColor=#3974AE><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><INPUT size=25 name=NAME></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"><B><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Amount of Coverage:</FONT></B></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><SELECT size=1 name=COVERAGE> <OPTION value=$500,000 selected>$500,000 <OPTION value=$300,000>$300,000 <OPTION value=$400,000>$400,000 <OPTION value=$500,000>$500,000 <OPTION value=$600,000>$600,000 <OPTION value=$700,000>$700,000 <OPTION value=$800,000>$800,000 <OPTION value=$900,000>$900,000 <OPTION value=$1,000,000>$1,000,000</OPTION> </SELECT></P></TD></TR><TR bgcolor=#3974AE><TD align=left><P style="MARGIN-LEFT: 5px"><B><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Date of Birth:</FONT></B></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px; MARGIN-RIGHT: -30px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Month</FONT> <SELECT name=MONTH2> <OPTION value=01 selected>01 <OPTION value=02>02 <OPTION value=03>03 <OPTION value=04>04 <OPTION value=05>05 <OPTION value=06>06 <OPTION value=07>07 <OPTION value=08>08 <OPTION value=09>09 <OPTION value=10>10 <OPTION value=11>11 <OPTION value=12>12</OPTION> </SELECT> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Day</FONT> <SELECT name=DAY2> <OPTION value=01 selected>01 <OPTION value=02>02 <OPTION value=03>03 <OPTION value=04>04 <OPTION value=05>05 <OPTION value=06>06 <OPTION value=07>07 <OPTION value=08>08 <OPTION value=09>09 <OPTION value=10>10 <OPTION value=11>11 <OPTION value=12>12 <OPTION value=13>13 <OPTION value=14>14 <OPTION value=15>15 <OPTION value=16>16 <OPTION value=17>17 <OPTION value=18>18 <OPTION value=19>19 <OPTION value=20>20 <OPTION value=21>21 <OPTION value=22>22 <OPTION value=23>23 <OPTION value=24>24 <OPTION value=25>25 <OPTION value=26>26 <OPTION value=27>27 <OPTION value=28>28 <OPTION value=29>29 <OPTION value=30>30 <OPTION value=31>31</OPTION> </SELECT> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Year</FONT><FONT face="Verdana, Arial, Helvetica, sans-serif" color=#000000 size=1> <SELECT name=year> <OPTION value="">Year <OPTION value=XX selected>Year</OPTION> <OPTION value=10>1910</OPTION> <OPTION value=11>1911</OPTION> <OPTION value=12>1912</OPTION> <OPTION value=13>1913</OPTION> <OPTION value=14>1914</OPTION> <OPTION value=15>1915</OPTION> <OPTION value=16>1916</OPTION> <OPTION value=17>1917</OPTION> <OPTION value=18>1918</OPTION> <OPTION value=19>1919</OPTION> <OPTION value=20>1920</OPTION> <OPTION value=21>1921</OPTION> <OPTION value=22>1922</OPTION> <OPTION value=23>1923</OPTION> <OPTION value=24>1924</OPTION> <OPTION value=25>1925</OPTION> <OPTION value=26>1926</OPTION> <OPTION value=27>1927</OPTION> <OPTION value=28>1928</OPTION> <OPTION value=29>1929</OPTION> <OPTION value=30>1930</OPTION> <OPTION value=31>1931</OPTION> <OPTION value=32>1932</OPTION> <OPTION value=33>1933</OPTION> <OPTION value=34>1934</OPTION> <OPTION value=35>1935</OPTION> <OPTION value=36>1936</OPTION> <OPTION value=37>1937</OPTION> <OPTION value=38>1938</OPTION> <OPTION value=39>1939</OPTION> <OPTION value=40>1940</OPTION> <OPTION value=41>1941</OPTION> <OPTION value=42>1942</OPTION> <OPTION value=43>1943</OPTION> <OPTION value=44>1944</OPTION> <OPTION value=45>1945</OPTION> <OPTION value=46>1946</OPTION> <OPTION value=47>1947</OPTION> <OPTION value=48>1948</OPTION> <OPTION value=49>1949</OPTION> <OPTION value=50>1950</OPTION> <OPTION value=51>1951</OPTION> <OPTION value=52>1952</OPTION> <OPTION value=53>1953</OPTION> <OPTION value=54>1954</OPTION> <OPTION value=55>1955</OPTION> <OPTION value=56>1956</OPTION> <OPTION value=57>1957</OPTION> <OPTION value=58>1958</OPTION> <OPTION value=59>1959</OPTION> <OPTION value=60>1960</OPTION> <OPTION value=61>1961</OPTION> <OPTION value=62>1962</OPTION> <OPTION value=63>1963</OPTION> <OPTION value=64>1964</OPTION> <OPTION value=65>1965</OPTION> <OPTION value=66>1966</OPTION> <OPTION value=67>1967</OPTION> <OPTION value=68>1968</OPTION> <OPTION value=69>1969</OPTION> <OPTION value=70>1970</OPTION> <OPTION value=71>1971</OPTION> <OPTION value=72>1972</OPTION> <OPTION value=73>1973</OPTION> <OPTION value=74>1974</OPTION> <OPTION value=75>1975</OPTION> <OPTION value=76>1976</OPTION> <OPTION value=77>1977</OPTION> <OPTION value=78>1978</OPTION> <OPTION value=79>1979</OPTION> <OPTION value=80>1980</OPTION> <OPTION value=81>1981</OPTION> <OPTION value=82>1982</OPTION> <OPTION value=83>1983</OPTION> <OPTION value=84>1984</OPTION> <OPTION value=85>1985</OPTION> <OPTION value=86>1986</OPTION> <OPTION value=87>1987</OPTION> <OPTION value=88>1988</OPTION> <OPTION value=89>1989</OPTION> <OPTION value=90>1990</OPTION> <OPTION value=91>1991</OPTION> <OPTION value=92>1992</OPTION> <OPTION value=93>1993</OPTION> <OPTION value=94>1994</OPTION> <OPTION value=95>1995</OPTION> <OPTION value=96>1996</OPTION> <OPTION value=97>1997</OPTION> <OPTION value=98>1998</OPTION> <OPTION value=99>1999</OPTION> <OPTION value=00>2000</OPTION> </SELECT></FONT></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"><B><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Sex:</FONT></B></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Male</FONT> <INPUT type=radio value=male name=SEX1> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Female</FONT> <INPUT type=radio value=female name=SEX1></P></TD></TR><TR bgcolor=#3974AE><TD align=left><DIV align=left><P style="MARGIN-LEFT: 5px"><B><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Height:</FONT></B></P></DIV></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><SELECT name=heightft> <OPTION value="" selected>Feet <OPTION value=3>3 Feet</OPTION> <OPTION value=4>4 Feet</OPTION> <OPTION value=5>5 Feet</OPTION> <OPTION value=6>6 Feet</OPTION> <OPTION value=7>7 Feet</OPTION> <OPTION value=8>8 Feet</OPTION> </SELECT> <SELECT name=heightin> <OPTION value="" selected>Inches <OPTION value=0>0 Inches</OPTION> <OPTION value=1>1 Inches</OPTION> <OPTION value=2>2 Inches</OPTION> <OPTION value=3>3 Inches</OPTION> <OPTION value=4>4 Inches</OPTION> <OPTION value=5>5 Inches</OPTION> <OPTION value=6>6 Inches</OPTION> <OPTION value=7>7 Inches</OPTION> <OPTION value=8>8 Inches</OPTION> <OPTION value=9>9 Inches</OPTION> <OPTION value=10>10 Inches</OPTION> <OPTION value=11>11 Inches</OPTION> </SELECT></P></TD></TR><TR><TD align=left><DIV align=left><P style="MARGIN-LEFT: 5px"><B><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Weight:</FONT></B></P></DIV></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><SELECT name=weight> <OPTION value="" selected>Please Select Your Weight</OPTION> <OPTION value=79>Under 80 lbs.</OPTION> <OPTION value=80>80 lbs.</OPTION> <OPTION value=81>81 lbs.</OPTION> <OPTION value=82>82 lbs.</OPTION> <OPTION value=83>83 lbs.</OPTION> <OPTION value=84>84 lbs.</OPTION> <OPTION value=85>85 lbs.</OPTION> <OPTION value=86>86 lbs.</OPTION> <OPTION value=87>87 lbs.</OPTION> <OPTION value=88>88 lbs.</OPTION> <OPTION value=89>89 lbs.</OPTION> <OPTION value=90>90 lbs.</OPTION> <OPTION value=91>91 lbs.</OPTION> <OPTION value=92>92 lbs.</OPTION> <OPTION value=93>93 lbs.</OPTION> <OPTION value=94>94 lbs.</OPTION> <OPTION value=95>95 lbs.</OPTION> <OPTION value=96>96 lbs.</OPTION> <OPTION value=97>97 lbs.</OPTION> <OPTION value=98>98 lbs.</OPTION> <OPTION value=99>99 lbs.</OPTION> <OPTION value=100>100 lbs.</OPTION> <OPTION value=101>101 lbs.</OPTION> <OPTION value=102>102 lbs.</OPTION> <OPTION value=103>103 lbs.</OPTION> <OPTION value=104>104 lbs.</OPTION> <OPTION value=105>105 lbs.</OPTION> <OPTION value=106>106 lbs.</OPTION> <OPTION value=107>107 lbs.</OPTION> <OPTION value=108>108 lbs.</OPTION> <OPTION value=109>109 lbs.</OPTION> <OPTION value=110>110 lbs.</OPTION> <OPTION value=111>111 lbs.</OPTION> <OPTION value=112>112 lbs.</OPTION> <OPTION value=113>113 lbs.</OPTION> <OPTION value=114>114 lbs.</OPTION> <OPTION value=115>115 lbs.</OPTION> <OPTION value=116>116 lbs.</OPTION> <OPTION value=117>117 lbs.</OPTION> <OPTION value=118>118 lbs.</OPTION> <OPTION value=119>119 lbs.</OPTION> <OPTION value=120>120 lbs.</OPTION> <OPTION value=121>121 lbs.</OPTION> <OPTION value=122>122 lbs.</OPTION> <OPTION value=123>123 lbs.</OPTION> <OPTION value=124>124 lbs.</OPTION> <OPTION value=125>125 lbs.</OPTION> <OPTION value=126>126 lbs.</OPTION> <OPTION value=127>127 lbs.</OPTION> <OPTION value=128>128 lbs.</OPTION> <OPTION value=129>129 lbs.</OPTION> <OPTION value=130>130 lbs.</OPTION> <OPTION value=131>131 lbs.</OPTION> <OPTION value=132>132 lbs.</OPTION> <OPTION value=133>133 lbs.</OPTION> <OPTION value=134>134 lbs.</OPTION> <OPTION value=135>135 lbs.</OPTION> <OPTION value=136>136 lbs.</OPTION> <OPTION value=137>137 lbs.</OPTION> <OPTION value=138>138 lbs.</OPTION> <OPTION value=139>139 lbs.</OPTION> <OPTION value=140>140 lbs.</OPTION> <OPTION value=141>141 lbs.</OPTION> <OPTION value=142>142 lbs.</OPTION> <OPTION value=143>143 lbs.</OPTION> <OPTION value=144>144 lbs.</OPTION> <OPTION value=145>145 lbs.</OPTION> <OPTION value=146>146 lbs.</OPTION> <OPTION value=147>147 lbs.</OPTION> <OPTION value=148>148 lbs.</OPTION> <OPTION value=149>149 lbs.</OPTION> <OPTION value=150>150 lbs.</OPTION> <OPTION value=151>151 lbs.</OPTION> <OPTION value=152>152 lbs.</OPTION> <OPTION value=153>153 lbs.</OPTION> <OPTION value=154>154 lbs.</OPTION> <OPTION value=155>155 lbs.</OPTION> <OPTION value=156>156 lbs.</OPTION> <OPTION value=157>157 lbs.</OPTION> <OPTION value=158>158 lbs.</OPTION> <OPTION value=159>159 lbs.</OPTION> <OPTION value=160>160 lbs.</OPTION> <OPTION value=161>161 lbs.</OPTION> <OPTION value=162>162 lbs.</OPTION> <OPTION value=163>163 lbs.</OPTION> <OPTION value=164>164 lbs.</OPTION> <OPTION value=165>165 lbs.</OPTION> <OPTION value=166>166 lbs.</OPTION> <OPTION value=167>167 lbs.</OPTION> <OPTION value=168>168 lbs.</OPTION> <OPTION value=169>169 lbs.</OPTION> <OPTION value=170>170 lbs.</OPTION> <OPTION value=171>171 lbs.</OPTION> <OPTION value=172>172 lbs.</OPTION> <OPTION value=173>173 lbs.</OPTION> <OPTION value=174>174 lbs.</OPTION> <OPTION value=175>175 lbs.</OPTION> <OPTION value=176>176 lbs.</OPTION> <OPTION value=177>177 lbs.</OPTION> <OPTION value=178>178 lbs.</OPTION> <OPTION value=179>179 lbs.</OPTION> <OPTION value=180>180 lbs.</OPTION> <OPTION value=181>181 lbs.</OPTION> <OPTION value=182>182 lbs.</OPTION> <OPTION value=183>183 lbs.</OPTION> <OPTION value=184>184 lbs.</OPTION> <OPTION value=185>185 lbs.</OPTION> <OPTION value=186>186 lbs.</OPTION> <OPTION value=187>187 lbs.</OPTION> <OPTION value=188>188 lbs.</OPTION> <OPTION value=189>189 lbs.</OPTION> <OPTION value=190>190 lbs.</OPTION> <OPTION value=191>191 lbs.</OPTION> <OPTION value=192>192 lbs.</OPTION> <OPTION value=193>193 lbs.</OPTION> <OPTION value=194>194 lbs.</OPTION> <OPTION value=195>195 lbs.</OPTION> <OPTION value=196>196 lbs.</OPTION> <OPTION value=197>197 lbs.</OPTION> <OPTION value=198>198 lbs.</OPTION> <OPTION value=199>199 lbs.</OPTION> <OPTION value=200>200 lbs.</OPTION> <OPTION value=201>201 lbs.</OPTION> <OPTION value=202>202 lbs.</OPTION> <OPTION value=203>203 lbs.</OPTION> <OPTION value=204>204 lbs.</OPTION> <OPTION value=205>205 lbs.</OPTION> <OPTION value=206>206 lbs.</OPTION> <OPTION value=207>207 lbs.</OPTION> <OPTION value=208>208 lbs.</OPTION> <OPTION value=209>209 lbs.</OPTION> <OPTION value=210>210 lbs.</OPTION> <OPTION value=211>211 lbs.</OPTION> <OPTION value=212>212 lbs.</OPTION> <OPTION value=213>213 lbs.</OPTION> <OPTION value=214>214 lbs.</OPTION> <OPTION value=215>215 lbs.</OPTION> <OPTION value=216>216 lbs.</OPTION> <OPTION value=217>217 lbs.</OPTION> <OPTION value=218>218 lbs.</OPTION> <OPTION value=219>219 lbs.</OPTION> <OPTION value=220>220 lbs.</OPTION> <OPTION value=221>221 lbs.</OPTION> <OPTION value=222>222 lbs.</OPTION> <OPTION value=223>223 lbs.</OPTION> <OPTION value=224>224 lbs.</OPTION> <OPTION value=225>225 lbs.</OPTION> <OPTION value=226>226 lbs.</OPTION> <OPTION value=227>227 lbs.</OPTION> <OPTION value=228>228 lbs.</OPTION> <OPTION value=229>229 lbs.</OPTION> <OPTION value=230>230 lbs.</OPTION> <OPTION value=231>231 lbs.</OPTION> <OPTION value=232>232 lbs.</OPTION> <OPTION value=233>233 lbs.</OPTION> <OPTION value=234>234 lbs.</OPTION> <OPTION value=235>235 lbs.</OPTION> <OPTION value=236>236 lbs.</OPTION> <OPTION value=237>237 lbs.</OPTION> <OPTION value=238>238 lbs.</OPTION> <OPTION value=239>239 lbs.</OPTION> <OPTION value=240>240 lbs.</OPTION> <OPTION value=241>241 lbs.</OPTION> <OPTION value=242>242 lbs.</OPTION> <OPTION value=243>243 lbs.</OPTION> <OPTION value=244>244 lbs.</OPTION> <OPTION value=245>245 lbs.</OPTION> <OPTION value=246>246 lbs.</OPTION> <OPTION value=247>247 lbs.</OPTION> <OPTION value=248>248 lbs.</OPTION> <OPTION value=249>249 lbs.</OPTION> <OPTION value=250>250 lbs.</OPTION> <OPTION value=251>251 lbs.</OPTION> <OPTION value=252>252 lbs.</OPTION> <OPTION value=253>253 lbs.</OPTION> <OPTION value=254>254 lbs.</OPTION> <OPTION value=255>255 lbs.</OPTION> <OPTION value=256>256 lbs.</OPTION> <OPTION value=257>257 lbs.</OPTION> <OPTION value=258>258 lbs.</OPTION> <OPTION value=259>259 lbs.</OPTION> <OPTION value=260>260 lbs.</OPTION> <OPTION value=261>261 lbs.</OPTION> <OPTION value=262>262 lbs.</OPTION> <OPTION value=263>263 lbs.</OPTION> <OPTION value=264>264 lbs.</OPTION> <OPTION value=265>265 lbs.</OPTION> <OPTION value=266>266 lbs.</OPTION> <OPTION value=267>267 lbs.</OPTION> <OPTION value=268>268 lbs.</OPTION> <OPTION value=269>269 lbs.</OPTION> <OPTION value=270>270 lbs.</OPTION> <OPTION value=271>271 lbs.</OPTION> <OPTION value=272>272 lbs.</OPTION> <OPTION value=273>273 lbs.</OPTION> <OPTION value=274>274 lbs.</OPTION> <OPTION value=275>275 lbs.</OPTION> <OPTION value=276>276 lbs.</OPTION> <OPTION value=277>277 lbs.</OPTION> <OPTION value=278>278 lbs.</OPTION> <OPTION value=279>279 lbs.</OPTION> <OPTION value=280>280 lbs.</OPTION> <OPTION value=281>281 lbs.</OPTION> <OPTION value=282>282 lbs.</OPTION> <OPTION value=283>283 lbs.</OPTION> <OPTION value=284>284 lbs.</OPTION> <OPTION value=285>285 lbs.</OPTION> <OPTION value=286>286 lbs.</OPTION> <OPTION value=287>287 lbs.</OPTION> <OPTION value=288>288 lbs.</OPTION> <OPTION value=289>289 lbs.</OPTION> <OPTION value=290>290 lbs.</OPTION> <OPTION value=291>291 lbs.</OPTION> <OPTION value=292>292 lbs.</OPTION> <OPTION value=293>293 lbs.</OPTION> <OPTION value=294>294 lbs.</OPTION> <OPTION value=295>295 lbs.</OPTION> <OPTION value=296>296 lbs.</OPTION> <OPTION value=297>297 lbs.</OPTION> <OPTION value=298>298 lbs.</OPTION> <OPTION value=299>299 lbs.</OPTION> <OPTION value=300>300 lbs.</OPTION> <OPTION value=301>301 lbs.</OPTION> <OPTION value=302>302 lbs.</OPTION> <OPTION value=303>303 lbs.</OPTION> <OPTION value=304>304 lbs.</OPTION> <OPTION value=305>305 lbs.</OPTION> <OPTION value=306>306 lbs.</OPTION> <OPTION value=307>307 lbs.</OPTION> <OPTION value=308>308 lbs.</OPTION> <OPTION value=309>309 lbs.</OPTION> <OPTION value=310>310 lbs.</OPTION> <OPTION value=311>311 lbs.</OPTION> <OPTION value=312>312 lbs.</OPTION> <OPTION value=313>313 lbs.</OPTION> <OPTION value=314>314 lbs.</OPTION> <OPTION value=315>315 lbs.</OPTION> <OPTION value=316>316 lbs.</OPTION> <OPTION value=317>317 lbs.</OPTION> <OPTION value=318>318 lbs.</OPTION> <OPTION value=319>319 lbs.</OPTION> <OPTION value=320>320 lbs.</OPTION> <OPTION value=321>321 lbs.</OPTION> <OPTION value=322>322 lbs.</OPTION> <OPTION value=323>323 lbs.</OPTION> <OPTION value=324>324 lbs.</OPTION> <OPTION value=325>325 lbs.</OPTION> <OPTION value=326>326 lbs.</OPTION> <OPTION value=327>327 lbs.</OPTION> <OPTION value=328>328 lbs.</OPTION> <OPTION value=329>329 lbs.</OPTION> <OPTION value=330>330 lbs.</OPTION> <OPTION value=331>331 lbs.</OPTION> <OPTION value=332>332 lbs.</OPTION> <OPTION value=333>333 lbs.</OPTION> <OPTION value=334>334 lbs.</OPTION> <OPTION value=335>335 lbs.</OPTION> <OPTION value=336>336 lbs.</OPTION> <OPTION value=337>337 lbs.</OPTION> <OPTION value=338>338 lbs.</OPTION> <OPTION value=339>339 lbs.</OPTION> <OPTION value=340>340 lbs.</OPTION> <OPTION value=341>341 lbs.</OPTION> <OPTION value=342>342 lbs.</OPTION> <OPTION value=343>343 lbs.</OPTION> <OPTION value=344>344 lbs.</OPTION> <OPTION value=345>345 lbs.</OPTION> <OPTION value=346>346 lbs.</OPTION> <OPTION value=347>347 lbs.</OPTION> <OPTION value=348>348 lbs.</OPTION> <OPTION value=349>349 lbs.</OPTION> <OPTION value=350>350 lbs.</OPTION> <OPTION value=351>351 lbs.</OPTION> <OPTION value=352>352 lbs.</OPTION> <OPTION value=353>353 lbs.</OPTION> <OPTION value=354>354 lbs.</OPTION> <OPTION value=355>355 lbs.</OPTION> <OPTION value=356>356 lbs.</OPTION> <OPTION value=357>357 lbs.</OPTION> <OPTION value=358>358 lbs.</OPTION> <OPTION value=359>359 lbs.</OPTION> <OPTION value=360>360 lbs.</OPTION> <OPTION value=361>361 lbs.</OPTION> <OPTION value=362>362 lbs.</OPTION> <OPTION value=363>363 lbs.</OPTION> <OPTION value=364>364 lbs.</OPTION> <OPTION value=365>365 lbs.</OPTION> <OPTION value=366>366 lbs.</OPTION> <OPTION value=367>367 lbs.</OPTION> <OPTION value=368>368 lbs.</OPTION> <OPTION value=369>369 lbs.</OPTION> <OPTION value=370>370 lbs.</OPTION> <OPTION value=371>371 lbs.</OPTION> <OPTION value=372>372 lbs.</OPTION> <OPTION value=373>373 lbs.</OPTION> <OPTION value=374>374 lbs.</OPTION> <OPTION value=375>375 lbs.</OPTION> <OPTION value=376>376 lbs.</OPTION> <OPTION value=377>377 lbs.</OPTION> <OPTION value=378>378 lbs.</OPTION> <OPTION value=379>379 lbs.</OPTION> <OPTION value=380>380 lbs.</OPTION> <OPTION value=381>Over 380 lbs.</OPTION> </SELECT></P></TD></TR><TR bgcolor=#3974AE><TD align=left><P style="MARGIN-LEFT: 5px"><B><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Occupation:</FONT></B></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><INPUT size=37 name=OCCUPATION1></P></TD></TR><TR><TD align=left colSpan=2><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px; MARGIN-LEFT: 5px"><B><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Have You Ever Had:</FONT></B></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>High Blood Pressure:</FONT>:</P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Yes</FONT> <INPUT type=radio value=yes name=HIGH_BLOOD_PRESSURE1> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>No</FONT> <INPUT type=radio CHECKED value=no name=HIGH_BLOOD_PRESSURE1></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Heart Attack or Stroke:</FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Yes</FONT> <INPUT type=radio value=yes name=HEART_ATTACK_OR_STROKE1> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>No</FONT> <INPUT type=radio CHECKED value=no name=HEART_ATTACK_OR_STROKE1></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Cancer:</FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Yes</FONT> <INPUT type=radio value=yes name=CANCER1> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>No</FONT> <INPUT type=radio CHECKED value=no name=CANCER1></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Diabetes:</FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Yes</FONT> <INPUT type=radio value=yes name=DIABETES1> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>No</FONT> <INPUT type=radio CHECKED value=no name=DIABETES1></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px; MARGIN-RIGHT: 5px"> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Smoked Within the</FONT></P><P style="MARGIN: -23px 5px 3px 22px"> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Last 12 months:</FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>Yes</FONT> <INPUT type=radio value=yes name=SMOKE_LAST_12_MO1> <FONT face="Verdana, Arial, Helvetica, sans-serif" size=2>No</FONT> <INPUT type=radio CHECKED value=no name=SMOKE_LAST_12_MO1></P></TD></TR><TR bgcolor=#3974AE><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px; MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>Person Completing Request:</B> </FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><INPUT size=39 value=" - Same As Above -" name=PERSON_COMPLETING_REQUEST></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>Mailing Address:</B></FONT><P style="MARGIN-LEFT: 5px"> </P><P style="MARGIN-LEFT: 5px"> </P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><TEXTAREA name=STREET rows=4 cols=35></TEXTAREA></P></TD></TR><TR bgcolor=#3974AE><TD align=left><P style="MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>City:</B></FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><INPUT size=28 name=CITY> </P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>State:</B></FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT color=#000000><SELECT name=state> <OPTION value="" selected>Select A State</OPTION> <OPTION value=AL>Alabama</OPTION> <OPTION value=AK>Alaska</OPTION> <OPTION value=AZ>Arizona</OPTION> <OPTION value=AR>Arkansas</OPTION> <OPTION value=CA>California</OPTION> <OPTION value=CO>Colorado</OPTION> <OPTION value=CT>Connecticut</OPTION> <OPTION value=DE>Delaware</OPTION> <OPTION value=DC>Dist. of Columbia</OPTION> <OPTION value=FL>Florida</OPTION> <OPTION value=GA>Georgia</OPTION> <OPTION value=HI>Hawaii</OPTION> <OPTION value=ID>Idaho</OPTION> <OPTION value=IL>Illinois</OPTION> <OPTION value=IN>Indiana</OPTION> <OPTION value=IA>Iowa</OPTION> <OPTION value=KS>Kansas</OPTION> <OPTION value=KY>Kentucky</OPTION> <OPTION value=LA>Louisiana</OPTION> <OPTION value=ME>Maine</OPTION> <OPTION value=MD>Maryland</OPTION> <OPTION value=MA>Massachusetts</OPTION> <OPTION value=MI>Michigan</OPTION> <OPTION value=MN>Minnesota</OPTION> <OPTION value=MS>Mississippi</OPTION> <OPTION value=MO>Missouri</OPTION> <OPTION value=MT>Montana</OPTION> <OPTION value=NE>Nebraska</OPTION> <OPTION value=NV>Nevada</OPTION> <OPTION value=NH>New Hampshire</OPTION> <OPTION value=NJ>NewJersey</OPTION> <OPTION value=NM>New Mexico</OPTION> <OPTION value=NY>New York</OPTION> <OPTION value=NC>North Carolina</OPTION> <OPTION value=ND>North Dakota</OPTION> <OPTION value=OH>Ohio</OPTION> <OPTION value=OK>Oklahoma</OPTION> <OPTION value=OR>Oregon</OPTION> <OPTION value=PA>Pennsylvania</OPTION> <OPTION value=RI>Rhode Island</OPTION> <OPTION value=SC>South Carolina</OPTION> <OPTION value=SD>South Dakota</OPTION> <OPTION value=TN>Tennessee</OPTION> <OPTION value=TX>Texas</OPTION> <OPTION value=UT>Utah</OPTION> <OPTION value=VT>Vermont</OPTION> <OPTION value=VA>Virginia</OPTION> <OPTION value=WA>Washington</OPTION> <OPTION value=WV>West Virginia</OPTION> <OPTION value=WI>Wisconsin</OPTION> <OPTION value=WY>Wyoming</OPTION> </SELECT></FONT></P></TD></TR><TR bgcolor=#3974AE><TD align=left><P style="MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>Zip Code:</B></FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><INPUT size=11 name=ZIP></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>Daytime Phone:</B></FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><INPUT size=22 name=DAY-PHONE></P></TD></TR><TR bgcolor=#3974AE><TD align=left><P style="MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>Evening Phone:</B></FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><INPUT size=22 name=EVE-PHONE></P></TD></TR><TR><TD align=left><P style="MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>Email Address:</B></FONT></P></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><INPUT maxLength=50 size=35 name=email></P></TD></TR><TR bgcolor=#3974AE><TD align=left><DIV align=left><P style="MARGIN-LEFT: 5px"><FONT face="Verdana, Arial, Helvetica, sans-serif" size=2><B>Best Time to Contact:</B></FONT></P></DIV></TD><TD align=left><P style="MARGIN-TOP: 3px; MARGIN-BOTTOM: 3px"><FONT color=#000000><SELECT tabIndex=1 size=1 name=besttime> <OPTION value=Anytime selected>Anytime</OPTION> <OPTION value="Morning (8:00 am - 10:00 am)">Morning (8:00 am - 10:00 am)</OPTION> <OPTION value="Morning (10:00 am - 12:00 pm)">Morning (10:00 am - 12:00 pm)</OPTION> <OPTION value="Afternoon (12:00 pm - 2:00 pm)">Afternoon (12:00 PM - 2:00 PM)</OPTION> <OPTION value="Afternoon (2:00 pm - 4:00 pm)">Afternoon (2:00 PM - 4:00 PM)</OPTION> <OPTION value="Afternoon (4:00 pm - 6:00 pm)">Afternoon (4:00 PM - 6:00 PM)</OPTION> <OPTION value="Evening (6:00 pm - 8:00 pm)">Evening (6:00 PM - 8:00 PM)</OPTION> </SELECT></FONT></P></TD></TR><TR><TD vAlign=top align=left height=41></TD><TD vAlign=top align=left height=41><P style="MARGIN-TOP: 6px"><FONT face="Verdana, Arial, Helvetica, sans-serif"><BASEFONT size=2><INPUT type=image src=http://us.f1yahoofs.com/users/1e1000e9/bc/friends/btn-submit.gif?bcQjy88Az.L4t4he border=0 name=submit></FONT></P></TD></TR><TR><TD colSpan=2 height=5></TD></TR></TBODY></TABLE></CENTER></DIV><P align=center><b><font size=2>When you click submit it may start your spell check, so please click "Ignore" if it does.</font></b></P></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE><DIV align=center><CENTER><TABLE cellSpacing=0 cellPadding=0 width=600 bgColor=#666666 border=0><TBODY><TR><TD bgColor=#000000> </TD></TR></TBODY></TABLE></CENTER></DIV></form><div align=center><center><table border=1 style="border-collapse: collapse" width=260 id=AutoNumber1 height=111 cellspacing=0 cellpadding=0 bgcolor=#000000><tr><td width=100% align=center height=22><font size=1 color=#FFFFFF>YOUR INTERNET ADVERTISING Copyright˙FFFFA91999-2002. All Rights Reserved</font></td></tr><tr><td width=100% height=16><p align=center><font face=Arial size=4 color=#91DF6A>This could be your ad!</font></td></tr><tr><td width=100% height=11><p align=center><font color=#cc0000 size=2 face=Arial><a style="color: #008080" href="mailto:lIIIlllIIlllllll@excite.com?subject=Direct Marketing Inquiry">Email Us</a> for free quotes and consultations.</font></td></tr><tr><td width=100% height=9><p align=center><font color=#FFFFFF><span style="font-size: 10.0pt; font-family: Times New Roman; font-style: italic">If you think, that you will not benefit from this correspondence, please </span><span style="font-family: Times New Roman; font-style: italic"><font size=2>reply with ˙FFFF93remove key˙FFFF94 as the subject matter.</font></span></font></td></tr></table></center></div></BODY></HTML>
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