MLC Financial Group LLC

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FINAL EXPENSE INSURANCE

Check your eligibility for Final Expense Insurance in minutes—no medical exam, no obligation.

Are you between the ages of 50 and 85?

Yes

No

Do you currently live in the United States?

Yes

No

Which best describes your health today?

Good

Fair

Managing a few conditions

Poor

Have you been hospitalized in the last 12 months?

Yes

No

Are you able to take care of daily activities on your own (bathing, dressing, eating)?

Yes

No

Have you ever been diagnosed with any of the following?

Heart Attack

Stroke

Cancer (within the last 2 years)

COPD or severe lung disease

Kidney failure or dialysis

Alzheimer's or dementia

None of the above

(check all that apply)

Have you used tobacco or nicotine products in the last 12 months? (Cigarettes, cigars, vaping, chewing tobacco, patches, etc.)

Yes

No

What is your main reason for looking into Final Expense coverage?

To cover funeral and burial costs

To avoid leaving bills to family

To leave something behind for loved ones

Just gathering information

About how much coverage do you fell comfortable with?

$5,000

$10,000

$15,000

$20,000 or more

Not sure - I'd like guidance

What is your age?

50- 59

60 - 69

70 - 79

80 - 85

What states do you live in?

We are currently licensed in the following states. Please select the state you are located in

What is the best time to contact you?

Morning

Afternoon

Evening

What is your full Name? *

What is the best phone number to reach you? *

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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

© 2026 Mike Capricciuolo / MLC Financial Group LLC — All Rights Reserved