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Tell us a little about what you need. One of our licensed insurance agents will review your information and contact you to discuss coverage options and prepare your quote.

Prefer to talk? Call us: 505-636-5052

Step 2 of 2 — Quote Request

Life Insurance

Start with a few basic details. A licensed Fortress Insurance Group LLC agent will contact you to discuss your goals and available coverage options.

Privacy Notice

Do not include your Social Security Number, bank account information, payment details, detailed medical records, or prescription information in this form. A licensed agent will guide you through any additional questions privately.

1Contact Information

First Name

Last Name

Phone Number

Email Address

ZIP Code

Preferred Contact Method

Insurance Type Requested

Life Insurance

2Basic Information

Date of Birth

What type of life insurance are you interested in?

Approximate amount of coverage you are considering

Primary reason for considering life insurance

Do you currently have life insurance?

YesNo

3General Eligibility

Just one quick preliminary question — your agent will walk you through any additional health questions privately.

Do you currently use tobacco or nicotine products?

YesNo

4Questions & Notes

What would you most like help understanding about life insurance? (optional)

I agree to be contacted by a licensed Fortress Insurance Group LLC agent by phone regarding this quote request.

Submitting this form does not bind, modify, or guarantee insurance coverage. Coverage is not effective until confirmed by a licensed insurance agent and the applicable insurance carrier.

Submitting this form does not bind, create, modify, reinstate, or cancel any insurance coverage. Coverage is only effective when confirmed in writing by a licensed representative of Fortress Insurance Group LLC. For urgent or time-sensitive policy matters, call 505-636-5052.

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Need assistance?

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300 Paseo de Peralta, Suite 213

Santa Fe, NM 87501