Please fill out and submit the form below and one of our agents will follow up with you regarding your life insurance needs.

   
Name :
Email :
Telephone :
Zip Code :
Gender :
Date of Birth :  -    -  
Height :
Weight :
    Smoker or Non-Smoker
Any medication taken :
Any current or past medical issues :
    Term or Universal (Permanent) Insurance
Face Amount of the Policy :
      


*If unsure, one of our agents can help you determine the proper coverage based on your needs.
 
     
 
 
Have any questions?
Feel free to contact our experienced agents with any of your questions.
info@tyreinsuranceagency.com
Office: (626) 285-7033
Fax: (626) 285-2409
5703 Temple City Boulevard
Temple City, CA 91780

 
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