Step 3

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#999933" TEXT="#080000" bgproperties="fixed" background="038006e0ddwnfv.png"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>A Full-service Internet Insurance Agency selling life, auto and home insurance.    </B></FONT><B>    </B></div> <div> <B>   </B><A HREF="index.htm" TARGET="_top" TITLE="A Fullservice Internet Insurance Agency "><U><B>home</B></U></A><B>  / </B><A HREF="id2.htm" TARGET="_top" TITLE="About Us"><U><B> About Us</B></U></A><B>  /  </B><A HREF="id3.htm" TARGET="_top" TITLE="Products"><U><B>Products </B></U></A><B> /  </B><A HREF="id4.htm" TARGET="_top" TITLE="Whats New"><U><B>What's New</B></U></A><B>  /  </B><A HREF="id5.htm" TARGET="_top" TITLE="Charities"><U><B>Charities</B></U></A><B>  /  </B><A HREF="id16.htm" TARGET="_top" TITLE="Directors"><U><B>Directors</B></U></A><B>  /  </B><A HREF="id6.htm" TARGET="_top" TITLE="Contact Us"><U><B>Contact Us</B></U></A></div> <div>  </div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#CCCC99" TEXT="#080000" background="039bec00esnpes.png"> <div> <A HREF="id9.htm" TARGET="_top" TITLE="Life"><U><B>Life</B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="Step 1."><U><B>Step1</B></U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Step 2 Type of Life insurance needed?"><U><B>Step 2</B></U></A></div> <div> <B>Step 3</B></div> <div> <B>Get Quote</B></div> <div> <B>Get a free quote from the Charitable Insurance Group.</B></div> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Step 3</div> <div> <B>Get life insurance Quote</B></div> <div> <B>Let us Shop the Market and find the most competitive quote</B></div> <bR> <div> <B><U> <form action="http://formmail.trellix.com/servlets/TlxMailer" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Company,Address1,Address2,City,State,Zip,Phone,Fax,Comments,[Custom]"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request for a quote. We guarantee a quote within 24 hours Mon.-Fri."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="Charitableinsurance@comcast.net"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Date of Birth:<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Do you or have you ever smoked?:<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address :<br> <input type="text" name="Address2" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Fax Number:<br> <input type="text" name="Fax" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Comments-Please include type of insurance requested ( ex: 20 year term) and any special medical conditions:<br> <textarea name="Comments" rows="8" cols="30"></textarea></td> </tr> <tr> <td align="left">Face Amount:<br> <input type="text" name="[Custom]" size="15" maxlength="50"></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </U></B></div> </td> </tr></table></body>