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Date: Sun, 09 Jul 2000 10:37:30 -0-1200
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To: engrtgm@snydertech.com
Subject: *** Save up to 70% on Your Life Insurance -FREE Quote                                          ***+a#nhjlekjh -nebbx
Message-Id: <3f161j3ib6.7md17oa0015r8wmr5j3k@202.224.39.60>

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   <title>Ins2</title>
<style>td {font-family: arial}</style>
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<body bgcolor="#FDF5E6">

<div STYLE="FONT-FAMILY:TIMES">
<center><b><font face="Georgia"><font color="#FF0000"><font size=+2>Save
Up To 70% on Your Life Insurance!</font></font></font></b>
<p><b><font color="#000000"><font size=+1>Why Spend&nbsp; More Than You
Have To?</font></font></b>
<p><b><font face="Georgia">Just fill out the simple 1 minute&nbsp; form
below, for an</font></b>
<br><b><font face="Georgia">accurate <font color="#FF0000">FREE </font><font 
color="#000000">q</font>uote</font></b>
<br><font size=+1>comparing the best values from among hundreds of the
nation's</font>
<br><font size=+1>top insurance companies!</font>
<p><u><font color="#FF0000">COMPARE YOUR CURRENT COVERAGE</font></u>
<br><font color="#FF0000">to these 10-year level term monthly sample 
premiums</font>
<br><font color="#FF0000">(20 and 30 year rates also 
available)</font></center>
</div>

<center><table WIDTH="468" BGCOLOR="#FFFFFF" >
<tr>
<td ALIGN=CENTER>&nbsp;</td>

<td ALIGN=CENTER COLSPAN="2">$250,000</td>

<td ALIGN=CENTER COLSPAN="2">$500,000</td>

<td ALIGN=CENTER COLSPAN="2">$1,000,000</td>
</tr>

<tr BGCOLOR="#003366">
<td STYLE="COLOR:WHITE">Age</td>

<td STYLE="COLOR:WHITE">Male</td>

<td STYLE="COLOR:WHITE">Female</td>

<td STYLE="COLOR:WHITE">Male</td>

<td STYLE="COLOR:WHITE">Female</td>

<td STYLE="COLOR:WHITE">Male</td>

<td STYLE="COLOR:WHITE">Female</td>
</tr>

<tr>
<td>30</td>

<td>$12</td>

<td>$11</td>

<td>$19</td>

<td>$15</td>

<td>$31</td>

<td>$27</td>
</tr>

<tr>
<td>40</td>

<td>$15</td>

<td>$13</td>

<td>$26</td>

<td>$21</td>

<td>$38</td>

<td>$37</td>
</tr>

<tr>
<td>50</td>

<td>$32</td>

<td>$24</td>

<td>$59</td>

<td>$43</td>

<td>$107</td>

<td>$78</td>
</tr>

<tr>
<td>60</td>

<td>$75</td>

<td>$46</td>

<td>$134</td>

<td>$87</td>

<td>$259</td>

<td>$161</td>
</tr>
</table></center>

<center>(Smoker rates also available)</center>

<p>
<hr SIZE=1>
<table>
<tr>
<td><form ACTION='mailto:bx135@china.com?subject=1k' METHOD=POST 
ENCTYPE=TEXT/PLAIN>*All
Fields required</td>
</tr>

<tr>
<td>First Name:</td>

<td><input NAME=FIRST_NAME></td>
</tr>

<tr>
<td>Last Name:</td>

<td><input NAME=LAST_NAME></td>
</tr>

<tr>
<td>Address:</td>

<td><input NAME=ADDRESS></td>
</tr>

<tr>
<td>City:</td>

<td><input NAME=CITY></td>
</tr>

<tr>
<td>State:</td>

<td><input NAME=STATE SIZE=2></td>
</tr>

<tr>
<td>Zip:</td>

<td><input NAME=ZIP_CODE></td>
</tr>

<tr>
<td>Day Phone:</td>

<td><input NAME=DAY_PHONE>(xxx-xxx-xxxx)</td>
</tr>

<tr>
<td>Evening Phone:</td>

<td><input NAME=EVENING_PHONE></td>
</tr>

<tr>
<td>Fax:</td>

<td><input NAME=FAX>(xxx-xxx-xxxx)</td>
</tr>

<tr>
<td>Email:</td>

<td><input NAME=EMAIL></td>
</tr>

<tr>
<td>Male or Female:</td>

<td><input NAME=MALE_OR_FEMALE></td>
</tr>

<tr>
<td>Date of Birth:</td>

<td><input NAME=DATE_OF_BIRTH SIZE=13>(mm/dd/yy)</td>
</tr>

<tr>
<td>Type of Insurance:</td>

<td><select NAME=TYPE_OF_INSURANCE SIZE=1><option>30 Yr Guaranteed Level
Term<option SELECTED>20 Yr Guaranteed Level Term<option>15 Yr Guaranteed
Level Term<option>10 Yr Guaranteed Level Term<option>Universal 
Life<option>2nd-to-die
(Survivorship Insurance)</select></td>
</tr>

<tr>
<td>Insurance Amount:</td>

<td><select NAME=INSURANCE_AMOUNT><option>$100,000<option>$150,
000<option>$200,000<option>$250,000<option>$300,000<option>$350,
000<option>$400,000<option>$450,000<option SELECTED>$500,000<option>$550,
000<option>$600,000<option>$650,000<option>$700,000<option>$750,
000<option>$800,000<option>$850,000<option>$900,000<option>$950,000<option>$1,
000,000<option>$1,500,000<option>$2,000,000<option>$2,500,000<option>$3,000,
000<option>$3,500,000<option>$4,000,000<option>$4,500,000<option>$5,000,
000<option>above
$5,000,000</select></td>
</tr>

<tr>
<td>Height:</td>

<td><input NAME=HEIGHT SIZE=10></td>
</tr>

<tr>
<td>Weight:</td>

<td><input NAME=WEIGHT SIZE=3>lbs</td>
</tr>

<tr>
<td>Tobacco Use:</td>

<td><select NAME=TOBACCO_USE SIZE=1><option SELECTED>(Please 
Select)<option>Have
never smoked or used nicotine<option>Used to smoke, but quit less than
1 yr ago<option>Used to smoke 1-3 yrs ago<option>Used to smoke 3-5 yrs
ago<option>Used to smoke over 5 yrs ago<option>Currently smoke 
cigarettes<option>Other
nicotine use-cigars/pipe/chew/patch</select></td>
</tr>

<tr>
<td>Health Status:</td>

<td><select NAME=HEALTH_STATUS><option SELECTED>(Please 
Select)<option>Excellent:
trim and athletic, no medications<option>Good: no infirmities and no 
medications<option>Fair:
slightly overweight or taking medication<option>Poor: have/had a serious
health condition</select></td>
</tr>

<tr>
<td>Health conditions?
<br><input NAME=HEALTHPROBS TYPE=RADIO VALUE=YES>Yes<input CHECKED 
NAME=HEALTHPROBS TYPE=RADIO VALUE=NO>No</td>

<td>Explain:
<br><textarea NAME=HEALTHPROBSDESC></textarea></td>
</tr>

<tr>
<td>Prescription medications?
<br><input NAME=TAKERX TYPE=RADIO VALUE=YES>Yes<input CHECKED NAME=TAKERX 
TYPE=RADIO VALUE=NO>No</td>

<td>Explain:
<br><textarea NAME=TAKERXDESC></textarea></td>
</tr>

<tr>
<td>Do you engage in any hazardous activities?
<br>(i.e. scuba,skydiving,private pilot,etc.)
<br><input NAME=HAZAVOCOCC TYPE=RADIO VALUE=YES>Yes<input CHECKED 
NAME=HAZAVOCOCC TYPE=RADIO VALUE=NO>No</td>

<td>Explain:
<br><textarea NAME=HAZAVOCOCCDESC></textarea></td>
</tr>

<tr>
<td>Did your parents or siblings have
<br>heart disease or cancer prior to age 60?
<br><input NAME=FAMILYHISTORY TYPE=RADIO 
VALUE=YES>Yes<input CHECKED NAME=FAMILYHISTORY TYPE=RADIO VALUE=NO>No</td>

<td>Explain:
<br><textarea NAME=FAMILYHISTORYDESC></textarea></td>
</tr>
</table>

<center><input TYPE=SUBMIT VALUE="Submit Quote Request"></center>

<table>
<tr>
<td STYLE="FONT-SIZE:10PT">All quotes will be from insurance companies
rated A-, A, A+ or A++ by A.M. Best. Actual premiums and coverage 
availability
will vary depending upon age, sex, state, health history and tobacco use.
THIS IS NOT AN OFFER OR CONTRACT TO BUY INSURANCE PRODUCTS, but rather
a confidential informational inquiry. All information submitted is strictly
confidential, and will be given to an insurance professional licensed in
your state of residence, who will contact you and provide your quote directly.

Further transmissions of this email may be stopped at no cost to you. <a 
href="mailto:rem711@123india.com">PLEASE
CLICK HERE</a> AND TYPE REMOVE.</td>
</tr>
</table>

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