Disability Insurance Quote

Applicant Information

First Name:

Last Name:

Address:

City:

SOUTH CAROLINA

Zip Code:

Daytime Phone:

Cell Phone:


Email:  (Required)


How Best To Contact You:
Select One Cell Phone Daytime Phone Email

Currently Insured:
Select One Yes No


Disability Insurance Information

Date of Birth:

Gender:
Select One Female Male
Height:

Weight:


Do You Smoke:
Select One Yes No

Currently Own Disability Insurance:
Select One Yes No

Type of Disability Insurance Owned:


Monthly Gross Income:
$

Occupation or Title:


Explain Job Responsibilities:


Are you a government employee:
Select One Yes No

Are you a business owner:
Select One Yes No



Disability Coverage Information

Length of Coverage Needed:
Select One Short Term (Less than 2 years) Long Term (2 years or more)

Disability Coverage For:
Select One Myself Only Me & Spouse Spouse Only

Type of Coverage Needed:
Select One Accident Only Health Only Accident & Health

Monthly Benefit Amount Desired:
Select Amount 1,500 1,750 2,000 2,250 2,500 3,000 3,500 4,000

Or Enter a Different Monthly Amount:
$

Benefit Period:
Select One 13 weeks (Short Term Policy Only) 26 weeks (Short Term Policy Only) 1 year (Short Term Policy Only) 2 years (Long Term Policy Only) 5 years (Long Term Policy Only) To Age 65 (Long Term Policy Only)

Elimination Period:
Select One None 60 days 90 days 180 days 1 year 2 years

Payment Mode:
Select One Annual Semi-Annual Quarterly Monthly


Explain any prior workers comp
or serious health issues below:




Question or Message:




Click the "Submit Quote Request"
button below to send your South
Carolina Disability Insurance request
to Russell-Massey & Company.


***By submitting this request you
acknowledge that this is neither
an offer to insure nor a guarantee
of insurance.***








We are a Columbia, SC insurance
agency offering affordable South
Carolina disability insurance quotes
in the following towns, cities and
counties in South Carolina:
Chapin, Arthurtown, Saluda, Terrace,
Sandwood, Arcadia Lakes, Cayce,
Olympia, Forest Acres, Dentsville,
Eau Claire, West Columbia, Springdale,
Denny Terrace, Belmont, St. Andrews,
Irmo, Oak Grove, Lexington, Galaxy,
Bluff Estates, Hazelwood Acres, State
Park, Haskell Heights, Lincolnshire,
Ballentine, Killian, Red Bank, South
Congaree, Edmund, Gilbert, Summit,
Gaston, Hopkins, Capitol View, Horrel
Hill, Fort Jackson, Pontiac, Elgin,
Blythewood, Camden, Richtex,
Whitehall, White Rock, Sumter, Lugoff,
Boykin, Rembert, Hagood, Horatio,
Stateburg, Borden, Wedgefield, Oswego,
Gadsden, Fort Motte, St. Matthews,
Swansea, Woodford, Winnsboro, Pelion,
Steedman, Samaria, Monetta,
Batesburg-Leesville, Stoney Hill,
Prosperity, Newberry, Peak, Little
Mountain, Slighs, Pomaria, Jenkinsville,
Rion, Winnsboro Mills, Simpson,
Smallwood, Ridgeway, Orangeburg,
Lexington County, Fairfield County,
Calhoun County, Sumter County,
Kershaw County, Saluda County,
and Richland County, SC. We can
also offer a South Carolina disability
insurance quote throughout the Palmetto
state, including in Florence, Greenville,
Spartanburg, Myrtle Beach, and
Charleston, SC.

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