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Self Service Life APPLICATION 

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By signing above I hereby authorize L|I|F|E Firm, Inc to shop on my behalf for the best possible protection for myself and/or the insured. I agree to the use of my signatures obtained in this electronic application to be used in applications by L|I|F|E Firm, Inc exclusively for the purpose of obtaining life insurance protection that I have requested for myself and/or the insured. I understand that submitting this application is not a promise of life insurance protection but instead provides L|I|F|E Firm, Inc with the required information to obtain such coverage on my behalf.

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