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Life / Health

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Andrew Jackson
Direct: (469) 277-6166
Email: andrew.jackson@paragonfg.com

  1. Which product(s) are you interested in?
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  12. Please answer all of the following questions:
  13. 1. Have you ever had a heart attack, angina, angioplasty, bypass surgery, chronic kidney or liver disorder, emphysema, hepatitis C, internal cancer, insulin-dependent diabetes, melanoma, or stroke? Are you HIV positive?
  14. YOU
  16. CO-BORROWER
  18. 2. Have you ever been treated for high blood pressure or high cholesterol? Has either of your natural parents or siblings died from coronary artery disease or cancer prior to age 60?
  19. YOU
  21. CO-BORROWER
  23. 3. Have you ever been treated for alcohol or drug abuse, asthma, colitis, Crohn's disease, depression/mental disorder, epilepsy, heart murmur, or type II diabetes? Had a DUI, reckless driving, or suspension in the past 5 years? Had more than two moving violations in the past 3 years?
  24. YOU
  26. CO-BORROWER
  28. 4. Have you used tobacco or nicotine products in the past 12 months?
  29. YOU
  31. CO-BORROWER
  33. 5. What is your gender?
  34. YOU
  36. CO-BORROWER
  38. 6. What is your age?
  41. 7. What is your height?
 

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