McGlawn Insurance Agency
Elkins Park, Pennsylvania  •  Toll Free: (888) 307-0505
Established 1985
Link:
Mortgage Protection Service

Serving:
Pennsylvania (PA),
Ohio (OH),
Delaware (DE), New York (NY), North Carolina (NC), South Carolina (SC), Virginia (VA), New Jersey (NJ),
Maryland (MD), Alabama (AL), Washington (WA), Florida (FL), Texas (TX)
Hours of Operation:
Monday–Friday
9:00 a.m.–5:30 p.m.

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*At this time our services are not provided in the following states: AL, HI, NM, OK, and SD

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Please answer all questions:
YOU
CO-BORROWER
(if coverage desired)
1. Have you ever had a heart attack, angina, angioplasty, bypass surgery, chronic kidney or liver disorder, emphysema, hepatitis C, internal cancer, insulin-dependent diabetes, melanoma, or stroke? Are you HIV positive?

  Yes   No
Yes   No
2. Have you ever been treated for high blood pressure or high cholesterol? Has either of your natural parents or siblings died from coronary artery disease or cancer prior to age 60?

  Yes   No
Yes   No
3. Have you ever been treated for alcohol or drug abuse, asthma, colitis, Crohn's disease, depression/mental disorder, epilepsy, heart murmur, or type II diabetes? Had a DUI, reckless driving, or suspension in the past 5 years? Had more than two moving violations in the past 3 years?
  Yes   No
Yes   No
4. Have you used tobacco or nicotine products in the past 12 months?
  Yes  No
Yes  No
5. What is your gender?
  Male  Female
Male  Female
6. What is your age?
 
7. What is your height?
               
8. What is your weight?