Your family. Your health. Your home. Your business. Each an important element of your life, which changes at a rapid pace. Are you able to ensure the security of each? Do you have plans in place to help safeguard yourself and your loved ones should your financial security be threatened? Are you and your family adequately insured? The proper coverage can provide you with protection, peace of mind, and a plan for the future.

Please answer the following questions to help us provide suggestions for consideration regarding your insurance needs.

1. What is your age?
Under 35 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69
2. Life Events
Check all that apply. a. Personal Events Getting married Have a mortgage/new home Have child(ren)/new baby Caring for aging parent(s) Sending child(ren) to college Other b. Career Events Nearing retirement Changing firms/opening a law office Making partner Other
3. What is the size of your firm?
1-5 6-20 21 or more a. What is your portion of the average monthly expenses for your office? (see Professional Overhead Insurance for eligible expenses) 0 $500 $1,000 $2,000 $4,000 $6,000 $8,000 $10,000
4. Indicate your current coverage:
a. Term Life Insurance (total): b. Monthly Disability Benefits:
5. What is your current income?
Current income:

This information will be used in the subsequent pages to provide you direction on your insurance needs and is not stored and is strictly confidential.