Phone# 517.545.3932
Home
Our Agency
Let's get started on protecting your most valuable asset, your life.
*
Indicates required field
Name
*
First
Last
Phone Number
*
Email
*
Date of Birth
*
Type
*
Term
Permanent
Height
*
Weight
*
Desired Amount
*
Do use any nicotine/tobacco products?
*
Yes
No
No, but I quit a year ago or less
Preferred Agent
*
Anyone
Paul Hukkala
Adam Hukkala
Have you or an immediate family member die or diagnosed with cancer or heart disease prior to age 60
*
Yes
No
Preferred Way To Contact
*
Phone (morning)
Phone (early afternoon)
Phone (evening)
Email
Do you take any medication? If yes, please provide details.
*
What's your motivation for seeking life insurance?
*
Submit
Home
Our Agency