Let’s Get Started!

Take the first step toward achieving your financial goals with an Indexed Universal Life (IUL) policy tailored to your needs. Whether you’re planning for retirement, building wealth, or securing your family’s future, we’re here to guide you every step of the way. Fill out the form below, and one of our experienced agents will reach out to assist you.

START TODAY!

Help us understand your needs and goals. Once submitted, you’ll have the option to book a call with us.

We’re excited to explore how we can help you achieve lasting financial security!

Section 1: Personal Information

(This helps us identify and communicate with you.)

Full Name *

Date of birth *

Street Address *

City

State

Country

Postal code

Phone *

Email *

Section 2: Financial Information

(This helps us determine the best policy structure for your financial situation.)

Annual Income *

$

*(Approximate amount, used to align your policy with your financial goals)*

Occupation *

*(For risk assessment and understanding your insurance needs.)*

What are your main financial goals with this policy?

Retirement savings

Tax-free income

Estate planning

Wealth protection

Other:

Section 3: Health Information

(Your health helps determine eligibility and premiums. All information remains confidential.)

Note: Some of these questions may require a brief medical exam, but rest assured, all personal health information is protected by law.

Do you currently take any medications? *

Yes

No

*(If yes, please provide general details.)*

Do you use tobacco products? *

Yes

No

*(This affects premium rates.)*

Do you engage in any high-risk activities (e.g., skydiving, scuba diving, etc.)? *

Yes

No

*(This helps us assess risk levels.)*

Section 4: Insurance Preferences

(Your answers will help us tailor the policy to your needs.)

Desired Coverage Amount (Death Benefit): *

Less than $100,000

$100,000 - $500,000

$500,000 - $1,000,000

Over $1,000,000

Preferred Premium Payment Schedule: *

Monthly

Quarterly

Annually

Do you have any existing life insurance policies? *

Yes

No

If yes, what type?

Section 5: Beneficiary Information

(This information is used to make sure the right people benefit from your policy.)

Primary Beneficiary Name & Relationship to You: *

*(Who would receive the benefit in case of your passing.)*

Contingent Beneficiary Name & Relationship: *

*(Optional: Who would receive the benefit if the primary beneficiary is unavailable.)*

Section 6: Additional Options (Optional)

(You can add extra benefits or riders to your policy.)

Would you like to include any of the following riders?

Long-Term Care

Waiver of Premium

Accelerated Death Benefit

Other:

By checking this box, you consent to us using your information solely to address your inquiry and provide relevant services. Your data will be kept confidential and never shared or sold. You can opt out at any time.

I have read and agree to the Privacy Policy.

About Us

We are dedicated to helping individuals and families achieve their financial goals through tailored insurance solutions. With expertise in Indexed Universal Life (IUL) policies, we provide guidance to secure your future, grow your wealth, and protect what matters most.

Privacy Policy

At Safe Dollar Plan, your privacy is our utmost priority. The information you share with us will be used exclusively for providing guidance and support tailored to your financial goals. We guarantee that your personal data will never be sold, shared, or used for any purpose beyond this consultation. Every piece of information you provide is treated with the highest level of confidentiality and handled securely to protect your trust in us. We are dedicated to safeguarding your privacy and ensuring a secure and respectful experience every step of the way.