Additional Insurance Coverage Application

If you wish to obtain additional insurance coverage at very competitive rates (rates that are highly subsidized from our earnings on investments), call the office at 215-557-6960 or email  for a rate quotation, then complete this form, print it out, and mail it to us with your initial premium payment.

Application for Insurance

Specify amount in $1,000 increments


To age 40: $150,000

Age 41-50: $100,000

Age 51-60: $75,000

Age 61-72: $50,000