COMPULIFE ® Software, Inc. (800) 798-3488

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Application to Purchase Website Quoter License (Canada)

The Website Quoter License permits you to add instant life insurance quotes to your website. You must be a subscriber to COMPULIFE's PC Software to take advantage of this offer.

If you are NOT a subscriber, click here for details about how to receive a 4 Month FREE subscription to Compulife including 4 FREE months of quotes for your website.

If you are already a subscriber to Compulife, but have never before used Compulife's online quote system, then you can have 4 months free.

Please complete the following Application
              * Required fields
I am a current subscriber to Compulife:  Yes   Click here if you are not a subscriber
The name on your current
licensed subscription:
(Your Name or Your Company Name) 
Phone Number:
E-mail Address:
Comfirm E-mail Address:
I would like to receive
the 4 FREE Months
of website quotes:
 Yes    No   NOTE: You are not obligated to renew after 4 months
Select a result template: 
What's this ?  
Select a color style: 
What's this ?  
 $105/year - Pro-rated to match your current subscription
                      after 4 Free Months
Select optional FREE add-ons:
These add-ons are available 
with the 4 Free Months.
 $24/year - Consumer ID  What's this ?
 $60/year - Health Analyzer  What's this ?
This add-on is NOT available 
in combination with the 4 Free 
Months. Must be paid up-front. 
 $50 - Needs Analysis Calculators (one-time charge)  What's this ?

NOTE:  For your security, we do not ask for your credit card information on our website. To pay by credit card, submit this application and then call us at (800) 567-8376 to process your payment.

If you would like to pay by check, please mail your payment with a printed application.

Once we receive payment, your website quoter instruction e-mail will be sent. After you place quotes on your website the rates are automatically updated until the end of your subscription period.

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