Clifton Insurance Agency
- Disability Insurance -

Disability Insurance

We are dedicated to protecting your most valuable asset. That asset is your ability to earn a living and insure that your family is taken care of. By contacting our agency you will receive hands on guidance and work directly with a qualified disability insurance representative. Did you know that 3 out of 10 individuals will become disabled this year or loose their ability to work? Submit your information below so that we can assist you with your disability insurance needs. Long term and short term disablity insurance is only a click away.

Please submit your contact information below so that Clifton Insurance Agency, Inc can contact you with a FREE quote!

Name *
 
Phone *
 
Email *
 
State *
 
I am interested in:
Disability Insurance:
Medical Malpractice Insurance:
Life Insurance:
Tail Only Malpractice Insurance:

D.O.B. *
 
Height
  Weight   
Prescription Medications:  
Tobacco Use? (If so what type)
Do you have a family history of heart disease, cancer or diabetes? (yes/no) describe if yes.
Any other medical condition?
Gross Income:
Are you married? :
Comments:
 
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Clifton Insurance Agency. All rights reserved. Sitemap
5408 S. Bell Building B Suite 310 Amarillo, Texas 79109
877-212-4368 Ext: 1
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