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What is your age?
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Desired Policy Level:
$50,000
$100,000
$150,000

Do you smoke?

Are you a current Allstate customer?

Do you own your residence?

Have you ever received drug or alcohol treatment?

In the past 3 months, have you been unable to perform the duties of your regular occupation for more than 10 consecutive days due to illness, injury, full or partial disability (excluding pregnancy)?

Have you been diagnosed with or treated for:
Stroke
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Kidney Disease
Heart Disease
Cancer
HIV/AIDs
Alzheimer’s
None of These

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