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Term Life Insurance Quote Tool   Complete the following form to receive an estimated premium for term life insurance. Date of Birth (mm/dd/yyyy)   / / State of Residence   Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Gender   Female   Male Have you used tobacco in the past five years (60 months)?   Yes No Weight   lbs. Height   4' 7'' or less 4' 8'' 4' 9'' 4' 10'' 4' 11'' 5' 0'' 5' 1'' 5' 2'' 5' 3'' 5' 4'' 5' 5'' 5' 6'' 5' 7'' 5' 8'' 5' 9'' 5' 10'' 5' 11'' 6' 0'' 6' 1'' 6' 2'' 6' 3'' 6' 4'' 6' 5'' 6' 6'' 6' 7'' 6' 8'' or more Coverage Period   10 years 15 years 20 years Coverage Amount   $250,000 $300,000 $350,000 $400,000 $450,000 $500,000 $550,000 $600,000 $650,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,600,000 $1,700,000 $1,800,000 $1,900,000 $2,000,000 $2,500,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 $5,000,000 $5,500,000 $6,000,000 $6,500,000 $7,000,000 $7,500,000 $8,000,000 $8,500,000 $9,000,000 $9,500,000 $10,000,000 Please Note Call a Fidelity Insurance Specialist at 800-642-6974 for a quote if any of the following apply to you: You are currently taking or been advised to take medication for blood pressure or cholesterol You or a family member have a history of coronary artery disease, diabetes or cancer You have had your driver's license suspended or revoked in the past 5 years Term insurance policies vary by state. Maximum issue age is 70 in most states. Fidelity Insurance Specialists are licensed insurance agents. Fidelity Investments Term Life Insurance (Policy Form Nos. FTL-96200, et al. and FTL-99200, et al.) is issued by Fidelity Investments Life Insurance Company, and in NY, Empire Fidelity Investments Term Life Insurance (Policy Form No. EFTL-99200, et al.) is issued by Empire Fidelity Investments Life Insurance Company®, New York, NY. Fidelity Insurance Agency, Inc. is the distributor.     © 1998–2010 FMR LLC. All rights reserved. Terms of Use  Privacy  Security  Site Map