Get In Touch

Don't navigate the complexities of Life Insurance alone - let Haymaker Insurance Solutions be your guide to peace of mind and protection for life.

Please answer the following questions so that your advisor can offer the best solution for you.

Full Name

Phone *

Email *

Postal code

Do you use any form of tobacco?

About how tall are you?

What is your best guess to your current weight?

Do you use any of the following devices?

CPAP

Oxygen

Wheelchair

Walker

In the last 2 years, have you been treated for or taken medication for any of the following?

Diabetes

High Blood Pressure

Asthma

COPD or Emphysema

Depression or Anxiety Disorder

Cancer

Heart Attack

Stroke

Cardiac Surgery (Stents, Pacemaker, Bypass, Ablation)

Congestive Heart Failure

Liver Disease or Hepatitis C

Dialysis or Kidney Disease

Parkinson's

Lupus

It is helpful for me to know a list of your prescriptions. If you have them handy, you can share them here. If none - type none.

If Approved, what payment method will you be using to cover your premiums?

Is there anything specific you would like your advisor to know before contating you?

(765) 307-5412

Indianapolis, IN