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Secure Your Loved Ones and Assets with the Power of Life Insurance

First, are you a Male or a Female? *

I am a male

I am a female

What is your age range? *

50 or younger

51 - 60 years old

61 - 70 years old

71 years old or older

Are you a smoker or non-smoker? *

I am a smoker

I am a non-smoker

Do you currently have any life insurance? *

Yes I do

No I do not

I don't know

If yes, what kind of policy and how much protection do you have? (outside of work)

Type of policy and amount

Have you been diagnosed with any major health issues? *

Yes I have

No I have not

How would you like to use your insurance policy? *

Funeral / Final Expense

Debt / Mortgage Protection

Leave money behind / Legacy

Income replacement for family

What is your First Name?

What is your best email address? *

What is your mobile number? (To confirm your questionnaire info and provide your custom plan) *

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SafeHaven Agency is privately owned and operated by Licensed Agent Austin Zulauf. Invitations for applications for insurance on

SafeHaven Agency only where licensed and appointed. Austin Zulauf is licensed to sell insurance products in the following states:

KY, OH, PA licensing information can be found here.