Request for Income Protection Insurance Quote< | Income Protection Quotes/title> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> <meta name="description" http-equiv="description" content="Income Protection Insurance Quote. Request for Income Protection Quotation. If you are looking for ther best income protection insurance or to compare incr=ome protection insurance, we can help."> <meta name="keywords" http-equiv="keywords" content="income protection quote, income protection quotes, income protection plan, income protection plans, income protection cover, income protection policy, income protection policies, income protection insurance australia, Income Protection, Income Protection insurance, quote, policy, income insurance, salary insurance, income protection australia, income insurance australia, salary continuance insurance, loss of income insurance, income protection comparison, income protection insurance comparison"> <link REL="STYLESHEET" TYPE="text/css" HREF="style.css"> </head> <body> <table align="center" width="800" border="0" cellspacing="0" cellpadding="0"> <tr> <td> <table align="center" width="800" border="0" cellspacing="0" cellpadding="0"> <tr> <td width="135" align="left"><a href="http://www.lifeinsuranceaust.com.au" style="text-decoration: none; font-size: 18px; font-weight: bold; color: #0053A1; font-family: tahoma;" title="Term & Whole of Life Insurance Broker">I<font style="font-size:14px">NSURANCE</font><br />A<font style="font-size:14px">CUMEN</font><br />A<font style="font-size:14px">USTRALIA</font></a> </td> <td valign="baseline"> <H1>Income Protection Insurance Quotation Form</H1> <h3 style="margin-left:15; margin-top:-10">From your Australian Life Insurance Broker</h3></td> <td align="right" width="195" valign="top"> <font style="font-size: 11px">A.L. & Associates Pty Ltd ~<br> Insurance Acumen Australia<br> ABN 89 665 380 320<br> <strong>Phone</strong>: 1300 766 467<br> <strong>Fax</strong>: 08 9316 4906 </font> </td> </tr> </table> </td> </tr> <tr bgcolor="#0053A1"> <td><img src="images/spacer.gif" width="1" height="1"></td> </tr> <tr> <td><img src="images/spacer.gif" width="1" height="1"></td> </tr> <tr bgcolor="#0053A1"> <td align="right">  <a class="topnav" href="http://www.lifeinsuranceaust.com.au/life_insurance_quote_form.shtml" title="Life Insurance Quote / Life Quote / Life Insurance Quotes / Life Quotes. Online Form to Request Quotation for Life Insurance">Life insurance quote</a> <font color="WHITE">|</font> <a class="topnav" href="http://www.lifeinsuranceaust.com.au/income_protection_insurance_quote_form.shtml" title="Income Protection Insurance Quote / Income Protection Insurance Quotes. Online Form to Request Quotation for Income Protection Insurance">Income protection insurance quote</a> <font color="WHITE">|</font> <a class="topnav" href="http://www.lifeinsuranceaust.com.au/trauma_insurance_quote_form.shtml" title="Trauma Insurance Quote / Diagnosis Insurance Quote / Trauma Insurance Quotes / Diagnosis Insurance Quotes. Online Form to Request Quotation for Trauma Insurance / Diagnosis Insurance">Trauma insurance quote</a> <font color="WHITE">|</font> <a class="topnav" href="http://www.lifeinsuranceaust.com.au/tpd_insurance_quote_form.shtml" title="Total and Permanent Disability Insurance Quote / TPD Insurance Quote / Total and Permanent Disability Insurance Quotes / TPD Insurance Quotes. Online Form to Request Quotation for Total and Permanent Disability Insurance (TPD Insurance)">TPD insurance quote</a> <font color="WHITE">|</font> <a class="topnav" href="http://www.lifeinsuranceaust.com.au/contact_us.shtml">Contact us</a> <font color="WHITE">|</font> <a class="topnav" href="mailto:info@lifeinsuranceaust.com.au">Email us</a> </td> </tr> <tr> <td><img src="images/spacer.gif" width="1" height="1"></td> </tr> <tr bgcolor="#951A2C"> <td><img src="images/spacer.gif" width="1" height="1"></td> </tr> <tr> <td> <table width="100%" border="0" cellpadding="0" cellspacing="3"> <tr> <td width="175" valign="top"> <table width="175" cellspacing="2" cellpadding="4" border="0"> <tr><td> <a class="leftnav" href="http://www.lifeinsuranceaust.com.au" title="Life Insurance Australia Home Page">Home Page</a></td></tr> <tr><td style="border-top: solid #951A2C 1px"><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life_insurance.shtml" title="All About Life Insurance">* LIFE INSURANCE</a> <br><strong>-></strong> <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life_insurance_quote_form.shtml" title="Life Insurance Quote / Life Quote. Online Form to Request Quotation for Life Insurance">Request quotation</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life-insurance-case-history-1.shtml" title="Life Insurance Case History.">Life Insurance Case History</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life_insurance_cover_guide.shtml" title="Guide to determine how much Life Insurance Cover is appropriate.">Guide to life insurance coverage / sum insured </a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life_insurance_cover_calculator.shtml" title="Life Insurance Cover Calculator">Life insurance cover calculator</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life_insurance_and_other_insurance.shtml" title="Life Insurance & Partnership Insurance.">LIFE INSURANCE & PARTNERSHIP INSURANCE</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life_insurance_and_other_insurance.shtml#key_person" title="Life Insurance & Key Person Insurance.">LIFE INSURANCE &<br />KEY PERSON INSURANCE</a></td></tr> <tr><td style="border-top: solid #951A2C 1px"><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/total_and_permanent_disability_insurance.shtml" title="All About Total & Permanent Disability Insurance (TPD Insurance)">* TOTAL & PERMANENT DISABILITY INSURANCE</a> <br><strong>-></strong> <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/tpd_insurance_quote_form.shtml" title="TPD Quote / Total and Permanent Dissbility Insurance Quote / TPD Quote. Online Form to Request Quotation for Total and Permanent Disability Insurance (TPD Insurance)">Request quotation</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/tpd-insurance-case-history-1.shtml" title="Trauma Insurance Case History.">TPD Case History 1</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/tpd-insurance-case-history-2.shtml" title="Trauma Insurance Case History.">TPD Case History 2</a></td></tr> <tr><td style="border-top: solid #951A2C 1px"><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/trauma_insurance.shtml" title="All About Trauma Insurance or Diagnosis Insurance">* TRAUMA INSURANCE</a> <br><strong>-></strong> <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/trauma_insurance_quote_form.shtml" title="Trauma insurance Quote / Trauma Quote. Online Form to Request Quotation for Trauma / Diagnosis Insurance">Request quotation</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/trauma-insurance-case-history-1.shtml" title="Trauma Insurance Case History.">Trauma Case History 1</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/trauma-insurance-case-history-2.shtml" title="Trauma Insurance Case History.">Trauma Case History 2</a></td></tr> <tr><td style="border-top: solid #951A2C 1px"><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/income_protection_insurance.shtml" title="All About Income Protection Insurance">* INCOME PROTECTION INSURANCE</a> <br><strong>-></strong> <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/income_protection_insurance_quote_form.shtml" title="income Protection insurance Quote / Income Protection Quote. Online Form to Request Quotation for Income Protection Insurance">Request quotation</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/income-protection-insurance-case-history-1" title="Income Protection Insurance Case History.">Income Protection Case</a></td></tr> <tr><td style="border-top: solid #951A2C 1px"><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/insurance_premium_costs.shtml" title="Factors that affect All Personal Risk Insurance Policy Premiums">Insurance cost factors</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/faqs.shtml" title="Frequently ASked Questions About Life Insurance">Frequently asked questions</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/testimonials.shtml" title="Testimonials - Life Insurance Broker">Testimonials</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/about_us.shtml" title="About Anne Davidson - Life Insurance Broker">About us</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/web_links.shtml" title="Useful & Related Web Links">Web links</a></td></tr> <tr><td><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/privacy.shtml" title="Privacy Statement - Life Insurance Broker">Your privacy</a></td></tr> <tr><td style="border-bottom: solid #951A2C 1px"><a class="leftnav" href="http://www.lifeinsuranceaust.com.au/contact_us.shtml" Title="How to Contact Life Insurance Australia">Contact us</a></td></tr> </table> </td> <td valign="top"> <h2>Request for Income Protection Insurance Quotation</h2> <p>This form is for you if you require an <a href="http://www.lifeinsuranceaust.com.au/income_protection_insurance_quote_form.shtml" title="Income Protection Insurance Quote | Income Insurance Quote">Income Protection Insurance Quote</a>. More information about <a href="http://www.lifeinsuranceaust.com.au/income_protection_insurance.shtml" title="All About Income Protection Insurance">Income Protection Insurance</a> is available on the <a href="http://www.lifeinsuranceaust.com.au/income_protection_insurance.shtml" title="All About Income Protection Insurance">Income Protection Insurance</a> page. If you have a general query or feedback, please complete the <a href="http://www.lifeinsuranceaust.com.au/contact_us.shtml">contact form</a>. Alternately, you can go to the following pages to submit a <a href="http://www.lifeinsuranceaust.com.au/life_insurance_quote_form.shtml" title="Online Form to Request Life Insurance Quote">life insurance quote</a> request,  <a href="http://www.lifeinsuranceaust.com.au/trauma_insurance_quote_form.shtml" title="Online Form to Request Trauma / Diagnosis Insurance Quote">trauma insurance quote</a> request or a <a href="http://www.lifeinsuranceaust.com.au/tpd_insurance_quote_form.shtml" title="Online Form to Request Total and Permanent Disability Insurance Quote (TPD Insurance Quote | TPD Quote)">tpd insurance quote</a> request. <p>Simply complete the following form and we will provide you with an Income Protection Insurance quote or Income Insurance quote so you can compare income protection insurance or have an income protection insurance comparison. <form action="/cgi-bin/FormMail.pl" method="POST"> <input type=hidden name="recipient" value="info@lifeinsuranceaust.com.au,webmaster@lifeinsuranceaust.com.au"> <input type=hidden name="redirect" value="http://www.lifeinsuranceaust.com.au/success_quote.shtml"> <input type=hidden name="required" value="email,First_Name,Last_Name,Date_of_Birth,Smoker,Occupation,Sex"> <input type=hidden name="env_report" value="REMOTE_HOST"> <input type=hidden name="sort" value="order:email,Title,First_Name,Last_Name,Date_of_Birth,Company_Name,Mobile_Number,Phone_Number,Contact_Method,Smoker,Sex,Occupation,Industry,Life_Cover_Required,Life_Cover_Amount,TPD_Cover_Required,TPD_Cover_Amount,Trauma_Cover_Required,Trauma_Cover_Amount,Income_Protection_Cover_Required,Income_Protection_Cover_Amount,Annual_Gross_Income,Address,Suburb,State,Annual_Gross_Income,Comments,Search_Engine"> <input type=hidden name="subject" value="Trauma / Diagnosis Insurance Quotation Request"> <input type=hidden name="missing_fields_redirect" value="http://www.lifeinsuranceaust.com.au/error_quote.shtml"> <p><strong>Note</strong>: Required fields are marked with a red asterisk. (<font Color="red">*</font>) <table width="100%" cellpadding="0" cellspacing="3" border="0"> <tr> <td align="right" nowrap width="30%"> Your Email Address<font Color="red">*</font>: </td> <td align="left"> <input class="required" type=text name="email" size="60" maxlength="100"> </td> </TR> <tr> <td align="right" nowrap width="30%"> Title: </td> <td align="left"> <select name="Title"> <option selected></option> <option>Mr.</option> <option>Mrs.</option> <option>Ms.</option> <option>Dr.</option> <option>Other</option> </select> </td> </TR> <tr> <td align="right" nowrap width="30%"> First Name<font color="#FF0000">*</font>: </td> <td align="left"> <input class="required" name="First_Name" size="60" maxlength="100"> </td> </TR> <tr> <td align="right" nowrap width="30%"> Last Name<font color="#FF0000">*</font>: </td> <td align="left"> <input class="required" name="Last_Name" size="60" maxlength="100"> </td> </TR> <tr> <td align="right" nowrap width="30%"> Date of Birth<font color="#FF0000">*</font>: </td> <td align="left"> <input class="required" name="Date_of_Birth" type="text" size="28" maxlength="60" value=""> DD/MM/YYYY </td> </TR> <tr> <td align="right" nowrap width="30%"> Mobile Number / Telephone Number : </td> <td align="left"> Mobile: <input name="Mobile_Number" type="text" size="15" maxlength="60" value=""> Telephone: <input name="Phone_Number" type="text" size="15" maxlength="60" value=""> </td> </TR> <tr> <td align="right" nowrap width="30%"> How to Contact You: </td> <td align="left"> <select name="Contact_Method"> <option selected>By Email</option> <option>By Mobile</option> <option>By Telephone</option> </select> </td> </TR> <tr> <td align="right" nowrap width="30%"> Are You A Smoker?<font color="#FF0000">*</font>: </td> <td align="left"> <select class="required" name="Smoker"> <option>Non Smoker</option><option>Smoker</option> </select> </td> </TR> <tr> <td align="right" nowrap width="30%"> Gender<font color="#FF0000">*</font>: </td> <td align="left"> <select name="Sex"> <option>MALE</option><option SELECTED>FEMALE</option> </select> </td> </TR> <tr> <td align="right" nowrap width="30%"> Occupation<font color="#FF0000">*</font>: </td> <td align="left"> <input class="required" name="Occupation" size="60" maxlength="100"> </td> </TR> <tr> <td align="right" nowrap width="30%"> Industry : </td> <td align="left"> <input name="Industry" size="60" maxlength="100"> </td> </TR> <tr> <td align="right" width="30%"> Do you require <strong>Income Protection Cover</strong>?:<br> If so how much cover do you require:<br> Please note most insurance companies limit the amount of income protection insurance cover to 75% of your annual income </td> <td align="left"> <select name="Income_Protection_Cover_Required"> <option selected>YES</option> <option>NO</option> </select> <strong>Income Protection</strong> Cover Required $<input name="TPD_Cover_Amount" type="text" size="12" value=""><br> Annual Gross Income: $ <input name="Annual_Gross_Income" type="text" size="12" value=""> </td> </TR> <tr> <td align="right" nowrap width="30%"> Do you require <strong>Trauma/Diagnosis Cover</strong>?:<br> (Lump sum for diagnosis of specific conditions)<br> If so how much cover do you require: </td> <td align="left"> <select name="Trauma_Cover_Required"> <option>YES</option> <option selected>NO</option> </select> <strong>Trauma/Diagnosis</strong> Cover Required $<input name="Trauma_Cover_Amount" type="text" size="12" value=""> </td> </TR> <tr> <td align="right" nowrap width="30%"> Do you require <strong>Life Cover</strong>:<br> (Lump sum on death)<br> If so how much cover do you require: </td> <td align="left"> <select name="Life_Cover_Required"> <option>YES</option> <option selected>NO</option> </select> <strong>Life</strong> Cover Required $<input name="Life_Cover_Amount" type="text" size="12" value=""> </td> </TR> <tr> <td align="right" nowrap width="30%"> Do you require <strong>TPD Cover</strong>?:<br> (Lump sum for permanent disablement)<br> If so how much cover do you require: </td> <td align="left"> <select name="TPD_Cover_Required"> <option>YES</option> <option selected>NO</option> </select> <strong>TPD</strong> Cover Required $<input name="TPD_Cover_Amount" type="text" size="12" value=""> </td> </TR> <tr> <td align="right" nowrap width="30%"> Company Name: </td> <td align="left"> <input name="Company_Name" size="60" maxlength="100"> </td> </TR> <tr> <td align="right" nowrap width="30%"> Address: </td> <td align="left"> <input name="Address" size="60" maxlength="120"> </td> </TR> <tr> <td align="right" nowrap width="30%"> Town or Suburb / State: </td> <td align="left"> <input name="Suburb" size="50" maxlength="100"> <select name="State"> <option>ACT</option> <option>NSW</option> <option>NT</option> <option>Qld.</option> <option>SA</option> <option>Tas.</option> <Option>VIC</Option> <option>WA</option> </select> </td> </TR> <tr> <td align="right" nowrap width="30%"> Comments/Requirements: </td> <td align="left"> <textarea name="Comments" cols="60" rows="5"></textarea> </td> </TR> <tr> <td align="right" nowrap width="30%"> How did you find us?: </td> <td align="left"> <select name="Search_Engine"> <option>Not Specified</option> <option>Google</option> <option>Yahoo/MSN</option> <option>Other Search Engine</option> <option>Other</option> </select> </td> </TR> <tr> <td align="center" nowrap width="30%" colspan="2"> <input type="submit" value="Submit Income Protection Insurance Quote Request"> </td> </TR> </table> </form> <h2>Further Inquiries</h2> <p>We welcome inquiries on our Life Insurance, Trauma Insurance, TPD Insurance & Income Protection Insurance products and insurance broker services. Please feel free to send us an <a href="mailto:info@lifeinsuranceaust.com.au">email</a>, call us on 1300 766 467, use our <a href="http://www.lifeinsuranceaust.com.au/contact_us.shtml">contact us</a> page to send us an online inquiry or submit a <a href="http://www.lifeinsuranceaust.com.au/life_insurance_quote_form.shtml" title="Life Insurance Quote. Online Form to Request Quotation for Life Insurance">life insurance quote</a>, <a href="http://www.lifeinsuranceaust.com.au/income_protection_insurance_quote_form.shtml" title="Income Protection Insurance Quote. Online Form to Request Quotation for Income Protection Insurance">income protection insurance quote</a>, <a href="http://www.lifeinsuranceaust.com.au/trauma_insurance_quote_form.shtml" title="Trauma Insurance Quote / Diagnosis Insurance Quote. Online Form to Request Quotation for Trauma Insurance / Diagnosis Insurance">trauma insurance quote</a> or <a href="http://www.lifeinsuranceaust.com.au/tpd_insurance_quote_form.shtml" title="Total and Permanent Dissability Insurance Quote. Online Form to Request Quotation for Total and Permanent Disability Insurance (TPD Insurance)">tpd insurance quote</a> form. We will contact you within 24 hours to answer your inquiry. <h2>DISCLAIMER</h2> <p>This web site does not provide financial or investment advice. The information herein is general material and does not take into account your personal and particular insurance, personal, or investment data or objectives or relevant needs. If we can assist with specific advice please <a href="http://www.lifeinsuranceaust.com.au/contact_us.shtml">contact us</a>. <br>  </td> </tr> </table> </td> </tr> <tr bgcolor="#0053A1"> <td><img src="images/spacer.gif" width="1" height="1"></td> </tr> <tr> <td><img src="images/spacer.gif" width="1" height="1"></td> </tr> <tr bgcolor="#0053A1"> <td align="center"> <font size="-2" color="#FFFFFF"> Anne Davidson, A.L. & Associates Pty Ltd ~ Insurance Acumen Australia (ABN 89 665 380 320) - Authorized Representative (237716) <br>of The Corporate Will Company Pty Ltd (ABN 82 009 145 886)  AFS Licence 247 086 <br>P.O. Box 1133, Canning Bridge WA 6153. Telephone: 1300 766 467 / (08) 9316 2572 · Facsimile: (08) 9316 4906 </font> </td> </tr> <tr> <td><img src="images/spacer.gif" width="1" height="1"></td> </tr> <tr bgcolor="#951A2C"> <td><img src="images/spacer.gif" width="1" height="1"></td> </tr> </table> <div align="center"> <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life_insurance.shtml" title="All About Life Insurance">Life Insurance</a> | <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/life_insurance_quote_form.shtml" title="Life Insurance Quote / Life Insurance Quotes / Life Quote / Life Quotes">Life Quote</a> | <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/total_and_permanent_disability_insurance.shtml" title="TPD Insurance">TPD</a> | <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/tpd_insurance_quote_form.shtml" title="TPD Insurance Quote / Total and Permanent Disability Insurance Quote / TPD Quote">TPD Quote</a> | <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/trauma_insurance.shtml" title="Trauma Insurance / Diagnosis Insurance">Trauma</a> | <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/trauma_insurance_quote_form.shtml" title="Trauma Insurance Quote / Diagnosis Insurance Quote / Trauma Quote">Trauma Insurance Quote</a> | <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/income_protection_insurance.shtml" title="Income Protection Insurance / income Protection Quote">Income Protection</a> | <a class="leftnav" href="http://www.lifeinsuranceaust.com.au/income_protection_insurance_quote_form.shtml" title="Income Protection Insurance Quote Form / Income Protection Quote">Income Protection Quote</a> </div> <script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-25596158-1']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 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